Provider Demographics
NPI:1467917864
Name:LEE, MARQUETTA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARQUETTA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 434
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:FL
Mailing Address - Zip Code:32658-0434
Mailing Address - Country:US
Mailing Address - Phone:352-339-3455
Mailing Address - Fax:
Practice Address - Street 1:2772 NW 43RD ST
Practice Address - Street 2:STE C
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606
Practice Address - Country:US
Practice Address - Phone:352-794-3861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-10
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW158951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical