Provider Demographics
NPI:1619433067
Name:WASHINGTON-MAWALI, LEE (MA)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:WASHINGTON-MAWALI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 BRIAR BAY BLVD APT 104
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-7408
Mailing Address - Country:US
Mailing Address - Phone:561-914-2236
Mailing Address - Fax:
Practice Address - Street 1:3500 BRIAR BAY BLVD APT 104
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-7408
Practice Address - Country:US
Practice Address - Phone:561-914-2236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0000Medicaid
FL1234Medicaid