Provider Demographics
NPI:1760824064
Name:LEE, PATIENCE MANINYANG (EDD)
Entity Type:Individual
Prefix:DR
First Name:PATIENCE
Middle Name:MANINYANG
Last Name:LEE
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 DEVEREAUX AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-5733
Mailing Address - Country:US
Mailing Address - Phone:215-356-6975
Mailing Address - Fax:
Practice Address - Street 1:7827 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2508
Practice Address - Country:US
Practice Address - Phone:215-356-6975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-27
Last Update Date:2013-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007035101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional