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NPI Code Detail

MEDICARE: LEGACY CONSULTING GROUP LLC

MEDICARE: LEGACY CONSULTING GROUP LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1942098868
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEGACY CONSULTING GROUP LLC
Provider Business Mailing Address
First Line : 2930 JASPER ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19134-3500
Country : US
Telephone Number : 267-225-5026
Fax Number :
Provider Business Practice Location Address
First Line : 2930 JASPER ST UNIT 220
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19134-3526
Country : US
Telephone Number : 267-225-5026
Fax Number :
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : ASHLEY SMITH
Credential : BCBA
Telephone Number : 267-225-5026
Provider Enumeration Date : 04/29/2025
Last Update Date : 01/12/2026

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Directions to “LEGACY CONSULTING GROUP LLC ” Practice Location

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