Provider Demographics
NPI:1710469960
Name:CHRISTO, LEA FONTAINE (LICSW)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:FONTAINE
Last Name:CHRISTO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 TWINBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-2709
Mailing Address - Country:US
Mailing Address - Phone:508-210-0422
Mailing Address - Fax:
Practice Address - Street 1:3 TWINBROOKE DR
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-2709
Practice Address - Country:US
Practice Address - Phone:508-210-0422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1022495-SW-LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical