Provider Demographics
NPI:1902983596
Name:LEGATO, MARILYN ANNE (APRN,C)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:ANNE
Last Name:LEGATO
Suffix:
Gender:F
Credentials:APRN,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 SPRINGFIELD AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1264
Mailing Address - Country:US
Mailing Address - Phone:908-508-1199
Mailing Address - Fax:
Practice Address - Street 1:2650 BAHIA VISTA ST STE 209
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2625
Practice Address - Country:US
Practice Address - Phone:941-870-7060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO003882300363LP0808X
FLAPRN11000352364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJLE002967Medicare ID - Type Unspecified