Active NPI
Raymond R Leclair, MFCC
- Mental Health Counselor
- Santa Cruz, CA
National Provider Identifier
1295841906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MFT4717
- Practice address
- 104 S Park Way
Santa Cruz, CA 95062-2202 - Phone
- (831) 427-2919
- Fax
- (831) 427-2919
- NPI assigned
- Aug 23, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MFT4717 | NY | Primary |
Addresses
Primary practice location
104 S Park Way
Santa Cruz, CA 95062-2202
Mailing address
104 S Park Way
Santa Cruz, CA 95062-2202
Phone (831) 427-2919
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 066811 | Other | CA | MANAGED HEALTH NETWORK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFT4717 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295841906",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 S PARK WAY",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "950622202",
"telephone_number": "831-427-2919",
"fax_number": "831-427-2919"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 S PARK WAY",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "950622202",
"telephone_number": "831-427-2919",
"fax_number": "831-427-2919"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LECLAIR",
"first_name": "RAYMOND",
"middle_name": "R",
"credential": "MFCC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "MFT4717",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MANAGED HEALTH NETWORK",
"identifier": "066811",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Cruz, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.