Provider Demographics
NPI:1760537682
Name:LEE, SUSAN K (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:K
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 1:251 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-2536
Mailing Address - Country:US
Mailing Address - Phone:650-307-7338
Mailing Address - Fax:650-299-4335
Practice Address - Street 1:1838 EL CAMINO REAL STE 220
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3110
Practice Address - Country:US
Practice Address - Phone:650-307-7338
Practice Address - Fax:650-299-4335
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 14008101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health