Provider Demographics
NPI:1639232572
Name:LEE, TAL (PSYD, LMSW)
Entity Type:Individual
Prefix:DR
First Name:TAL
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PSYD, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DOWNING ST
Mailing Address - Street 2:1P
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-4734
Mailing Address - Country:US
Mailing Address - Phone:212-366-6778
Mailing Address - Fax:
Practice Address - Street 1:10 DOWNING ST
Practice Address - Street 2:1P
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-4734
Practice Address - Country:US
Practice Address - Phone:212-366-6778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060059-11041C0700X
NY018061103TC0700X, 103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis