Provider Demographics
NPI:1831131044
Name:LEE, REBECCA B (LCSW)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:B
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 1:638 W IRIS DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3191
Mailing Address - Country:US
Mailing Address - Phone:615-975-7084
Mailing Address - Fax:615-292-4459
Practice Address - Street 1:638 W IRIS DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3191
Practice Address - Country:US
Practice Address - Phone:615-975-7084
Practice Address - Fax:615-292-4459
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW 31201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3695729Medicaid
TN4031438OtherBC/BS RASAC
TN9457223OtherCIGNA
TN3695729Medicare ID - Type Unspecified