Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 022976-1 | NY |
Y | 103T00000X | Psychologist | 022976-1 | NY |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TF0200X | Forensic Psychologist | ||
N | 103TM1800X | Intellectual & Developmental Disabilities | ||
N | 103TP2701X | Group Psychotherapist |
NPI | 1588999460 |
---|---|
Provider Name | Dr. Desiree A Leboeuf |
First Address | Canton, NY 13617-0245 |
Second Address | Canton, NY 13617-1026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2009 |
Last Update Date | 03/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
150533556 | (05) | NY |