Provider Demographics
NPI:1306966304
Name:LECLERC, AMY REBECCA
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:REBECCA
Last Name:LECLERC
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 1:2863 GREENDALE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-1722
Mailing Address - Country:US
Mailing Address - Phone:941-223-2257
Mailing Address - Fax:
Practice Address - Street 1:2863 GREENDALE RD
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-1722
Practice Address - Country:US
Practice Address - Phone:941-223-2257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist