Provider Demographics
NPI:1467985937
Name:LEE, LIV (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:LIV
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 ROUTE 73 N STE 320
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3426
Mailing Address - Country:US
Mailing Address - Phone:215-774-1166
Mailing Address - Fax:
Practice Address - Street 1:2000 HAMILTON ST STE 301
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-3874
Practice Address - Country:US
Practice Address - Phone:215-774-1166
Practice Address - Fax:215-279-8383
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006064133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered