Provider Demographics
NPI:1689618134
Name:ERBE LEGGETT, JENNIFER ALYSSA (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ALYSSA
Last Name:ERBE LEGGETT
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-2004
Mailing Address - Country:US
Mailing Address - Phone:617-851-0171
Mailing Address - Fax:
Practice Address - Street 1:82 MARLBOROUGH ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2020
Practice Address - Country:US
Practice Address - Phone:617-851-0171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0412821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical