Provider Demographics
NPI:1538202957
Name:LEBLANC, JOY LEE (RN MSN CS)
Entity type:Individual
Prefix:MS
First Name:JOY
Middle Name:LEE
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:RN MSN CS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 233
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01036-0233
Mailing Address - Country:US
Mailing Address - Phone:413-781-2910
Mailing Address - Fax:413-746-3932
Practice Address - Street 1:10 CENTRAL ST
Practice Address - Street 2:SUITE 27
Practice Address - City:W SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-2700
Practice Address - Country:US
Practice Address - Phone:413-781-2910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA174506363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1891774Medicaid
R96740Medicare UPIN
MALEN50420Medicare ID - Type Unspecified