Provider Demographics
NPI:1083662381
Name:LEGACY, SUE GENARO (LCSW)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:GENARO
Last Name:LEGACY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-7412
Mailing Address - Country:US
Mailing Address - Phone:512-496-6700
Mailing Address - Fax:512-496-6700
Practice Address - Street 1:12741 N HWY 183
Practice Address - Street 2:SUITE 300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4388
Practice Address - Country:US
Practice Address - Phone:512-331-6005
Practice Address - Fax:512-331-0505
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS269211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical