Provider Demographics
NPI:1326595612
Name:LEE, MATTHEW C (BS, CADC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:C
Last Name:LEE
Suffix:
Gender:M
Credentials:BS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SUMMER LN
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:CT
Mailing Address - Zip Code:06447-1462
Mailing Address - Country:US
Mailing Address - Phone:860-841-5068
Mailing Address - Fax:
Practice Address - Street 1:4 SUMMER LN
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:CT
Practice Address - Zip Code:06447-1462
Practice Address - Country:US
Practice Address - Phone:860-841-5068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-05
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03-334093101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)