Provider Demographics
NPI:1700974144
Name:LEGUM, JONATHAN JIMMY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:JIMMY
Last Name:LEGUM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:155 W 81ST ST
Mailing Address - Street 2:6C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-7215
Mailing Address - Country:US
Mailing Address - Phone:212-724-0079
Mailing Address - Fax:212-724-0079
Practice Address - Street 1:316 W 82ND ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5356
Practice Address - Country:US
Practice Address - Phone:212-724-0079
Practice Address - Fax:212-724-0079
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR057885-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY357979OtherMHN
NYP3662467OtherOXFORD HEALTH PLANS
NYR057885OtherHIP HEALTH PLANS
NYR057885OtherHIP HEALTH PLANS