Provider Demographics
NPI:1174666077
Name:LEE, PAMELA PROCTER
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:PROCTER
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:PROCTER
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:1 BOYD DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-1865
Mailing Address - Country:US
Mailing Address - Phone:978-390-5800
Mailing Address - Fax:978-465-5245
Practice Address - Street 1:69 SUMMER ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-5855
Practice Address - Country:US
Practice Address - Phone:978-390-5800
Practice Address - Fax:978-465-5245
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5850101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM1343OtherBCBSMA