Provider Demographics
NPI:1215566799
Name:LEE, YOUNGJAE (LCSW)
Entity Type:Individual
Prefix:
First Name:YOUNGJAE
Middle Name:
Last Name:LEE
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 1:2185 LEMOINE AVE
Mailing Address - Street 2:UNIT 1C
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6030
Mailing Address - Country:US
Mailing Address - Phone:877-959-8180
Mailing Address - Fax:866-535-3188
Practice Address - Street 1:2185 LEMOINE AVE
Practice Address - Street 2:UNIT 1C
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6030
Practice Address - Country:US
Practice Address - Phone:877-959-8180
Practice Address - Fax:866-535-3188
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057578001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical