Provider Demographics
NPI:1568605566
Name:LEE, RENEE C (MSED, BCBA)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:C
Last Name:LEE
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DEER PATH
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4616
Mailing Address - Country:US
Mailing Address - Phone:631-447-2179
Mailing Address - Fax:631-207-8441
Practice Address - Street 1:1 DEER PATH
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4616
Practice Address - Country:US
Practice Address - Phone:631-447-2179
Practice Address - Fax:631-207-8441
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1052635103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst