Provider Demographics
NPI:1659670719
Name:LEE, GRACE T (LCSW)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:T
Last Name:LEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19000 HOMESTEAD RD
Mailing Address - Street 2:EAST LOBBY
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-0712
Mailing Address - Country:US
Mailing Address - Phone:408-366-4374
Mailing Address - Fax:408-366-4388
Practice Address - Street 1:19000 HOMESTEAD RD
Practice Address - Street 2:EAST LOBBY
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-0712
Practice Address - Country:US
Practice Address - Phone:408-366-4374
Practice Address - Fax:408-366-4388
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 213531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical