Provider Demographics
NPI:1003001165
Name:GOLDSTEIN, LEE EDWIN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:EDWIN
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:670 ALBANY ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2646
Mailing Address - Country:US
Mailing Address - Phone:617-414-8361
Mailing Address - Fax:617-414-7073
Practice Address - Street 1:670 ALBANY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2646
Practice Address - Country:US
Practice Address - Phone:617-414-8361
Practice Address - Fax:617-414-7073
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1529622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry