Provider Demographics
NPI:1679095939
Name:LEE, VERNA MARIE (COORDINATOR)
Entity Type:Individual
Prefix:
First Name:VERNA
Middle Name:MARIE
Last Name:LEE
Suffix:
Gender:F
Credentials:COORDINATOR
Other - Prefix:
Other - First Name:VERNA
Other - Middle Name:MARIE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 MICHAELS RUN
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-7539
Mailing Address - Country:US
Mailing Address - Phone:570-730-3109
Mailing Address - Fax:570-730-4445
Practice Address - Street 1:118 MICHAELS RUN
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-7539
Practice Address - Country:US
Practice Address - Phone:570-730-3109
Practice Address - Fax:570-730-4445
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0000000000000000000101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor