Provider Demographics
NPI:1922098797
Name:LEE, LAMONT R (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAMONT
Middle Name:R
Last Name:LEE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:24645 RANCHO CALIF RD
Mailing Address - Street 2:STE 109
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590
Mailing Address - Country:US
Mailing Address - Phone:951-296-0323
Mailing Address - Fax:951-296-0326
Practice Address - Street 1:29645 RANCHO CALIFORNIA RD
Practice Address - Street 2:109
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6200
Practice Address - Country:US
Practice Address - Phone:951-296-0323
Practice Address - Fax:951-296-0326
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY5254103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL52541Medicare ID - Type UnspecifiedMEDICARE