Provider Demographics
NPI:1184684193
Name:JAMISON, LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:JAMISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:GT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230
Mailing Address - Country:US
Mailing Address - Phone:413-528-1845
Mailing Address - Fax:413-528-3667
Practice Address - Street 1:67 PROSPECT AVE
Practice Address - Street 2:SUITE 290
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-2917
Practice Address - Country:US
Practice Address - Phone:518-697-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0248151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN5M451Medicare ID - Type Unspecified