Provider Demographics
NPI:1821544545
Name:WASSER, LEE MASON (LMHC)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:MASON
Last Name:WASSER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 ACACIA RD
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-2403
Mailing Address - Country:US
Mailing Address - Phone:631-672-7156
Mailing Address - Fax:
Practice Address - Street 1:496 SMITHTOWN BYP STE 203
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5011
Practice Address - Country:US
Practice Address - Phone:631-606-6173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011036101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health