Provider Demographics
NPI:1013342773
Name:THE LEGGETT GROUP LLC
Entity Type:Organization
Organization Name:THE LEGGETT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ALYSSA
Authorized Official - Last Name:ERBE LEGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-851-0171
Mailing Address - Street 1:4238 WASHINGTON ST STE 316
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-2517
Mailing Address - Country:US
Mailing Address - Phone:617-851-0171
Mailing Address - Fax:
Practice Address - Street 1:4238 WASHINGTON ST STE 316
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-2517
Practice Address - Country:US
Practice Address - Phone:617-851-0171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA111254261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)