Healthcare Provider Details

I. General information

NPI: 1689618134
Provider Name (Legal Business Name): JENNIFER ALYSSA ERBE LEGGETT MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 MARLBOROUGH ST
BOSTON MA
02116-2020
US

IV. Provider business mailing address

5 LINCOLN ST
MILTON MA
02186-2004
US

V. Phone/Fax

Practice location:
  • Phone: 617-851-0171
  • Fax:
Mailing address:
  • Phone: 617-851-0171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number041282
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: