Provider Demographics
NPI:1942386271
Name:ODESCALCHI, LEE WESSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:WESSON
Last Name:ODESCALCHI
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 1:24 DAVIS AVENUE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603
Mailing Address - Country:US
Mailing Address - Phone:845-505-7495
Mailing Address - Fax:845-635-2283
Practice Address - Street 1:24 DAVIS AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603
Practice Address - Country:US
Practice Address - Phone:845-505-7495
Practice Address - Fax:845-635-2283
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013095-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
417844OtherMVP HEALTH CARE
734933OtherVALUEOPTIONS
7908540OtherAETNA
137407OtherVALUEOPTIONS
7349337OtherVALUEOPTIONS