Provider Demographics
NPI:1063297042
Name:LEGGETT, RALEIGH LAMONT III (LMSW)
Entity type:Individual
Prefix:
First Name:RALEIGH
Middle Name:LAMONT
Last Name:LEGGETT
Suffix:III
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 FOREST ST APT A6
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-3256
Mailing Address - Country:US
Mailing Address - Phone:860-639-6752
Mailing Address - Fax:
Practice Address - Street 1:349 BROAD. ST
Practice Address - Street 2:SUITE 204
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095
Practice Address - Country:US
Practice Address - Phone:860-335-6985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7366104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker