Provider Demographics
NPI:1730168998
Name:LEGINO, MARY QUATTROCCHI (PHD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:QUATTROCCHI
Last Name:LEGINO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4917 UNDERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-2421
Mailing Address - Country:US
Mailing Address - Phone:402-556-1516
Mailing Address - Fax:
Practice Address - Street 1:4917 UNDERWOOD AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-2421
Practice Address - Country:US
Practice Address - Phone:402-556-1516
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE191103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENE191OtherSTATE LICENSE NUMBER
NE8152OtherBLUE CROSS PROVIDER NUMBE
NENE191OtherSTATE LICENSE NUMBER