Provider Demographics
NPI:1710252127
Name:DR. DONALD R LEE-EDWARDS PH.D, LP
Entity Type:Organization
Organization Name:DR. DONALD R LEE-EDWARDS PH.D, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEE-EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,LP
Authorized Official - Phone:347-500-7785
Mailing Address - Street 1:255 GORDON ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1943
Mailing Address - Country:US
Mailing Address - Phone:347-500-7785
Mailing Address - Fax:
Practice Address - Street 1:255 GORDON ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-1943
Practice Address - Country:US
Practice Address - Phone:347-500-7785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4053692261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health