Provider Demographics
NPI:1558667006
Name:LECLAIR, DEBRA ANNE (PSYD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANNE
Last Name:LECLAIR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ANNE
Other - Last Name:KROHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:55 S COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-2606
Mailing Address - Country:US
Mailing Address - Phone:603-296-0830
Mailing Address - Fax:603-296-0839
Practice Address - Street 1:55 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-2606
Practice Address - Country:US
Practice Address - Phone:603-296-0830
Practice Address - Fax:603-296-0839
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH944103TB0200X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities