Provider Demographics
NPI:1174747216
Name:LEGEROS, MELANIE K (LICSW)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:K
Last Name:LEGEROS
Suffix:
Gender:F
Credentials:LICSW
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Mailing Address - Street 1:1153 CENTRE ST
Mailing Address - Street 2:DEPT. OF SOCIAL WORK, FAULKNER HOSPITAL
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3446
Mailing Address - Country:US
Mailing Address - Phone:617-983-7854
Mailing Address - Fax:617-983-7455
Practice Address - Street 1:1153 CENTRE ST
Practice Address - Street 2:DEPT. OF SOCIAL WORK, FAULKNER HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-3446
Practice Address - Country:US
Practice Address - Phone:617-983-7854
Practice Address - Fax:617-983-7455
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1133451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical