Provider Demographics
NPI:1225464464
Name:LEE, JAE YOUNG (MSW)
Entity Type:Individual
Prefix:MS
First Name:JAE
Middle Name:YOUNG
Last Name:LEE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 WASHINGTON ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3745
Mailing Address - Country:US
Mailing Address - Phone:617-983-5800
Mailing Address - Fax:
Practice Address - Street 1:3815 WASHINGTON ST
Practice Address - Street 2:SUITE #2
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3745
Practice Address - Country:US
Practice Address - Phone:617-983-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical