Provider Demographics
NPI:1275102907
Name:LEE, GERALDINE ELIZABETH (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:ELIZABETH
Last Name:LEE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 FIVE CROWN ROYAL
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2843
Mailing Address - Country:US
Mailing Address - Phone:609-529-0949
Mailing Address - Fax:
Practice Address - Street 1:105 FIVE CROWN ROYAL
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2843
Practice Address - Country:US
Practice Address - Phone:609-529-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW009934104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty