Provider Demographics
NPI:1407545023
Name:LEGER, MARYELLEN (LMHC)
Entity Type:Individual
Prefix:
First Name:MARYELLEN
Middle Name:
Last Name:LEGER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 GRAND CENTRAL PKWY APT C1206
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-8408
Mailing Address - Country:US
Mailing Address - Phone:516-351-1110
Mailing Address - Fax:
Practice Address - Street 1:6120 GRAND CENTRAL PKWY APT C1206
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-8408
Practice Address - Country:US
Practice Address - Phone:516-351-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012570101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health