Provider Demographics
NPI:1083097323
Name:LEE, CASEY MCCAFFREY
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:MCCAFFREY
Last Name:LEE
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 1:10040 HIGHWAY 9
Mailing Address - Street 2:APT 1
Mailing Address - City:BEN LOMOND
Mailing Address - State:CA
Mailing Address - Zip Code:95005-9248
Mailing Address - Country:US
Mailing Address - Phone:831-818-1189
Mailing Address - Fax:
Practice Address - Street 1:12 CARR ST
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4710
Practice Address - Country:US
Practice Address - Phone:831-768-8132
Practice Address - Fax:831-768-7593
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor