Provider Demographics
NPI:1376034454
Name:LEE, AMY (PSYD, BCBA, PMH-C)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PSYD, BCBA, PMH-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 5TH AVE
Mailing Address - Street 2:SUITE 1802
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:646-517-0708
Mailing Address - Fax:
Practice Address - Street 1:8011 18TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1705
Practice Address - Country:US
Practice Address - Phone:646-517-0708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
FLTPPY1464103TC0700X
NJNJDCATEMP-048026103TC0700X
1-21-51095103K00000X
NY024804103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst