Provider Demographics
NPI:1093396970
Name:LEE, RAVEN (LMSW)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 AIKEN ST APT 361
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-2029
Mailing Address - Country:US
Mailing Address - Phone:845-475-4952
Mailing Address - Fax:
Practice Address - Street 1:50 AIKEN ST APT 361
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-2029
Practice Address - Country:US
Practice Address - Phone:845-475-4952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5685104100000X
NY111378104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker