Provider Demographics
NPI:1144731050
Name:LEGENDY, MINEKO ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:MINEKO ANNE
Middle Name:
Last Name:LEGENDY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MINEKO ANNE
Other - Middle Name:
Other - Last Name:ONOUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:527 LINCOLN PL APT 402
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-6211
Mailing Address - Country:US
Mailing Address - Phone:917-273-2779
Mailing Address - Fax:
Practice Address - Street 1:30 E 21ST ST APT 2A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7217
Practice Address - Country:US
Practice Address - Phone:917-273-2779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022410103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist