Provider Demographics
NPI:1417013772
Name:LEE, RICHARD FERDINAND (LICENSED CLINICAL SO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:FERDINAND
Last Name:LEE
Suffix:
Gender:M
Credentials:LICENSED CLINICAL SO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 ST MARKS AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-5424
Mailing Address - Country:US
Mailing Address - Phone:516-378-8069
Mailing Address - Fax:
Practice Address - Street 1:399 CONKLIN STREET
Practice Address - Street 2:SUITE 304
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-2614
Practice Address - Country:US
Practice Address - Phone:516-378-8069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02299611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY146664OtherEMPIRE INSURANCE VALUE OP
NY0009591OtherGHI INSURANCE VALUE OPTIO
NY0009591OtherGHI INSURANCE VALUE OPTIO