Provider Demographics
NPI:1457827024
Name:LEE, JESSICA DANIELLE (PMHNP BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DANIELLE
Last Name:LEE
Suffix:
Gender:F
Credentials:PMHNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 SPRUCE TRL
Mailing Address - Street 2:
Mailing Address - City:WOOLWICH TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-4005
Mailing Address - Country:US
Mailing Address - Phone:203-417-3377
Mailing Address - Fax:
Practice Address - Street 1:4833 HULMEVILLE RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-3099
Practice Address - Country:US
Practice Address - Phone:800-245-4746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019418363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health