Provider Demographics
NPI:1588196752
Name:LEGERE-REARDON, RAE L (LMSW)
Entity Type:Individual
Prefix:
First Name:RAE
Middle Name:L
Last Name:LEGERE-REARDON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MORNING MIST RD
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-3522
Mailing Address - Country:US
Mailing Address - Phone:203-278-1616
Mailing Address - Fax:
Practice Address - Street 1:39A WATERBURY RD
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1249
Practice Address - Country:US
Practice Address - Phone:203-758-3570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3231104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker