Provider Demographics
NPI:1902478647
Name:LEGENDRE, MILO
Entity Type:Individual
Prefix:MR
First Name:MILO
Middle Name:
Last Name:LEGENDRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 1ST AVE APT 3D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2279
Mailing Address - Country:US
Mailing Address - Phone:315-278-1649
Mailing Address - Fax:
Practice Address - Street 1:1069 1ST AVE APT 3D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2279
Practice Address - Country:US
Practice Address - Phone:315-278-1649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty