Provider Demographics
NPI:1578936266
Name:LEE, SHENIQUA M (LMHC)
Entity Type:Individual
Prefix:
First Name:SHENIQUA
Middle Name:M
Last Name:LEE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-6114
Mailing Address - Country:US
Mailing Address - Phone:631-335-3166
Mailing Address - Fax:
Practice Address - Street 1:565 BROADHOLLOW RD STE 6E
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-4830
Practice Address - Country:US
Practice Address - Phone:631-664-7488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NY012739101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator