Provider Demographics
NPI:1376393967
Name:SCOTT, LEA (LCSW)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:
Other - Last Name:PENNINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:610 INDIAN BEAD RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-8900
Mailing Address - Country:US
Mailing Address - Phone:765-201-0518
Mailing Address - Fax:
Practice Address - Street 1:1305 CUMBERLAND AVE STE 205
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1348
Practice Address - Country:US
Practice Address - Phone:765-201-0518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34011044A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical