Provider Demographics
NPI:1275985871
Name:LEE, TERRAINE (18145)
Entity Type:Individual
Prefix:
First Name:TERRAINE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:18145
Other - Prefix:
Other - First Name:TERRAINE
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:18145
Mailing Address - Street 1:18 VARICK HOMES
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-4660
Mailing Address - Country:US
Mailing Address - Phone:845-561-5783
Mailing Address - Fax:845-561-0243
Practice Address - Street 1:172 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-4912
Practice Address - Country:US
Practice Address - Phone:845-561-5783
Practice Address - Fax:845-561-5783
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18145101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)