Provider Demographics
NPI:1982700209
Name:LEGGETT, CAROLINE WALKER (LICSW)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:WALKER
Last Name:LEGGETT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3799
Mailing Address - Country:US
Mailing Address - Phone:978-635-8700
Mailing Address - Fax:978-635-8920
Practice Address - Street 1:321 MAIN ST
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3799
Practice Address - Country:US
Practice Address - Phone:978-635-8700
Practice Address - Fax:978-635-8920
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1027810101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA460342OtherTUFTS HEALTH PLAN
MAP07457OtherBC/BS
MA110031987AMedicaid
MAP21085OtherMEDICARE
MA1858009Medicaid