Individual
DR. DESIREE A LEBOEUF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
74 STATE ST, CANTON, NY 13617-1026
(315) 261-9210
Mailing address
74 STATE ST, CANTON, NY 13617-1026
(315) 261-9210
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
022976-1
NY
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TF0200X
Forensic Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022976
LICENSE/CERTIFICATION #
NY
Enumeration date
10/09/2009
Last updated
02/03/2024
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