Provider Demographics
NPI:1710532478
Name:PIRES, LEA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:PIRES
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 EVERETT AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-3107
Mailing Address - Country:US
Mailing Address - Phone:860-304-5760
Mailing Address - Fax:
Practice Address - Street 1:2 CORPORATION WAY STE 260
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7932
Practice Address - Country:US
Practice Address - Phone:978-531-2904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2019041753363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health