Provider Demographics
NPI:1861493520
Name:CHASE, LEE RUBIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:RUBIN
Last Name:CHASE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10721 MAIN ST
Mailing Address - Street 2:SUITE 2350
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6914
Mailing Address - Country:US
Mailing Address - Phone:703-591-5912
Mailing Address - Fax:703-591-7210
Practice Address - Street 1:10721 MAIN ST
Practice Address - Street 2:SUITE 2350
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6914
Practice Address - Country:US
Practice Address - Phone:703-591-5912
Practice Address - Fax:703-591-7210
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002159103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical