=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699071548
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NOREEN LEGARE PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2011
-----------------------------------------------------
Last Update Date | 02/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2888 MAHAN DR STE 1
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32308-5465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-681-0681
-----------------------------------------------------
Fax | 850-681-0284
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2888 MAHAN DR STE 1
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32308-5465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-681-0681
-----------------------------------------------------
Fax | 850-681-0284
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MT1133
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------