Provider Demographics
NPI:1619385655
Name:LEGRAND, SHEILA (MA)
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:
Last Name:LEGRAND
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 925
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-0010
Mailing Address - Country:US
Mailing Address - Phone:617-319-7203
Mailing Address - Fax:
Practice Address - Street 1:344 MAIN ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-8007
Practice Address - Country:US
Practice Address - Phone:781-862-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303287Medicaid
MAM18633OtherBCBS
MA1303287OtherMBHP
MA042611055OtherTAX ID
MA0000023532OtherBMC
MA1004745OtherNPH
MA99618201OtherNETWORK HEALTH