Provider Demographics
NPI:1164554804
Name:ANDERSON, LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 KENNETT PIKE
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317
Mailing Address - Country:US
Mailing Address - Phone:610-388-1920
Mailing Address - Fax:610-388-6617
Practice Address - Street 1:260 KENNETT PIKE
Practice Address - Street 2:
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317
Practice Address - Country:US
Practice Address - Phone:610-388-1920
Practice Address - Fax:610-388-6617
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008607L103T00000X
DEBI0000376103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist