Provider Demographics
NPI:1760678957
Name:KERN, LEE SANDLER (LCSW)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:SANDLER
Last Name:KERN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 PICKETT RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-6005
Mailing Address - Country:US
Mailing Address - Phone:919-313-3124
Mailing Address - Fax:919-490-0191
Practice Address - Street 1:3017 PICKETT RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-6005
Practice Address - Country:US
Practice Address - Phone:919-313-3124
Practice Address - Fax:919-490-0191
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0005661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical