Provider Demographics
NPI:1285647644
Name:BORRINE, M LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:M LEE
Middle Name:
Last Name:BORRINE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-2913
Mailing Address - Country:US
Mailing Address - Phone:314-960-6713
Mailing Address - Fax:314-644-5427
Practice Address - Street 1:2626 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-2913
Practice Address - Country:US
Practice Address - Phone:314-960-6713
Practice Address - Fax:314-644-5427
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY 01515103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000070736Medicare ID - Type Unspecified