Provider Demographics
NPI:1649660705
Name:SLAUGHTER, LEA CHRISTINE
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:CHRISTINE
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:CHRISTINE
Other - Last Name:MCNEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:260 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-3534
Mailing Address - Country:US
Mailing Address - Phone:617-491-1269
Mailing Address - Fax:
Practice Address - Street 1:260 BEACON ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143
Practice Address - Country:US
Practice Address - Phone:617-491-1269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)