Provider Demographics
NPI:1386852275
Name:PICOS-LEE, MAYRA GLORIA
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:GLORIA
Last Name:PICOS-LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 W LANCASTER AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:DEVON
Mailing Address - State:PA
Mailing Address - Zip Code:19333-1592
Mailing Address - Country:US
Mailing Address - Phone:610-995-2800
Mailing Address - Fax:
Practice Address - Street 1:237 W LANCASTER AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:DEVON
Practice Address - State:PA
Practice Address - Zip Code:19333-1592
Practice Address - Country:US
Practice Address - Phone:610-995-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist