Provider Demographics
NPI:1902245186
Name:ROBILLARD, LESLIE A
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:ROBILLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62A ARCH ST
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-3731
Mailing Address - Country:US
Mailing Address - Phone:508-366-6605
Mailing Address - Fax:
Practice Address - Street 1:62A ARCH ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-3731
Practice Address - Country:US
Practice Address - Phone:508-366-6605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1004745OtherNHP
MA1303287OtherMBHP
MA042611055OtherTAX ID
MA1004745OtherFALLON
MAM18633OtherBCBS
MA99618201OtherNETWORK HEALTH
MA0000023532OtherBMC