Provider Demographics
NPI:1568615409
Name:LEE, SARAH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:LAMPORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1117 S HAYWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2603
Mailing Address - Country:US
Mailing Address - Phone:781-883-6860
Mailing Address - Fax:
Practice Address - Street 1:1117 S HAYWORTH AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2603
Practice Address - Country:US
Practice Address - Phone:781-883-6860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078026104100000X
CALCSW704361041C0700X
MA1193131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY158615409Medicare PIN