Provider Demographics
NPI:1316196033
Name:LEE, GRACE P (JD, PHD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:P
Last Name:LEE
Suffix:
Gender:F
Credentials:JD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E 57TH ST
Mailing Address - Street 2:SUITE 640
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2049
Mailing Address - Country:US
Mailing Address - Phone:212-888-8199
Mailing Address - Fax:212-888-2298
Practice Address - Street 1:115 E 57TH STREET
Practice Address - Street 2:SUITE 640
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4030
Practice Address - Country:US
Practice Address - Phone:212-888-8199
Practice Address - Fax:212-888-2298
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017804103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical