Provider Demographics
NPI:1609003219
Name:LEGARE, KATHLEEN A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:A
Last Name:LEGARE
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 1:130 OLD TOWN RD
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-2322
Mailing Address - Country:US
Mailing Address - Phone:860-896-5331
Mailing Address - Fax:860-896-5334
Practice Address - Street 1:281 HARTFORD TPKE
Practice Address - Street 2:SUITE G4
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4784
Practice Address - Country:US
Practice Address - Phone:860-896-5331
Practice Address - Fax:860-896-5334
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0048291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical