Provider Demographics
NPI:1740681329
Name:LACLAIR, CHRISTINE
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:LACLAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1715
Mailing Address - Country:US
Mailing Address - Phone:978-514-1974
Mailing Address - Fax:617-661-7277
Practice Address - Street 1:97 CENTRAL ST
Practice Address - Street 2:SUITE 207
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1917
Practice Address - Country:US
Practice Address - Phone:978-514-1974
Practice Address - Fax:978-710-5752
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2381101YA0400X
MA2199641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)