Provider Demographics
NPI:1104432269
Name:FREITAS, LEA ANNE
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:ANNE
Last Name:FREITAS
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 1:1230 BRIDGE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01850-1261
Mailing Address - Country:US
Mailing Address - Phone:978-455-3397
Mailing Address - Fax:978-459-9096
Practice Address - Street 1:1230 BRIDGE ST STE 1
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01850-1261
Practice Address - Country:US
Practice Address - Phone:978-455-3397
Practice Address - Fax:978-459-9096
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor