Provider Demographics
NPI:1215321534
Name:LEBLANC, STAR ETOILE (PHD)
Entity type:Individual
Prefix:DR
First Name:STAR ETOILE
Middle Name:
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E 33RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9401
Mailing Address - Country:US
Mailing Address - Phone:646-501-4439
Mailing Address - Fax:
Practice Address - Street 1:305 E 33RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9401
Practice Address - Country:US
Practice Address - Phone:646-501-4439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005952-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist