Provider Demographics
NPI:1215594031
Name:LEE, SHENIA MARIA
Entity Type:Individual
Prefix:
First Name:SHENIA
Middle Name:MARIA
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6415 STANLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3130
Mailing Address - Country:US
Mailing Address - Phone:708-995-3833
Mailing Address - Fax:708-795-4834
Practice Address - Street 1:6415 STANLEY AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3130
Practice Address - Country:US
Practice Address - Phone:708-995-3833
Practice Address - Fax:708-795-4834
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor