Individual
MS. LEA ANN CARR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
1040 WALTHAM ST, LEXINGTON, MA 02421-8033
(781) 761-5089
Mailing address
1040 WALTHAM ST, APT 206, LEXINGTON, MA 02421-8033
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1107410
MA
103K00000X
Behavior Analyst
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000023532
BMC
MA
01
—
042611055
TAX ID
MA
01
—
1004745
FALLON
MA
01
—
13003287
MBHP
MA
01
—
99618201
NETWORK HEALTH
MA
01
—
M18633
BCBS
MA
Enumeration date
01/03/2011
Last updated
06/13/2016
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