Provider Demographics
NPI:1366943078
Name:LEGERE, PETER ROBERT (BA, LADC II)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:ROBERT
Last Name:LEGERE
Suffix:
Gender:M
Credentials:BA, LADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 HOLBECK COR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-8241
Mailing Address - Country:US
Mailing Address - Phone:508-277-1079
Mailing Address - Fax:
Practice Address - Street 1:50 ALDRIN RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4827
Practice Address - Country:US
Practice Address - Phone:508-830-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty