Provider Demographics
NPI:1891907259
Name:LEE, MARIE KIM (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:KIM
Last Name:LEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24445 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6562
Mailing Address - Country:US
Mailing Address - Phone:310-464-6363
Mailing Address - Fax:310-464-6363
Practice Address - Street 1:24445 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6562
Practice Address - Country:US
Practice Address - Phone:310-464-6363
Practice Address - Fax:310-464-6363
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20674103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical