Provider Demographics
NPI:1942505631
Name:LEE, BENJAMIN DAVID (PSYD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:DAVID
Last Name:LEE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 LEXINGTON ST
Mailing Address - Street 2:STE 202
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02466-1356
Mailing Address - Country:US
Mailing Address - Phone:617-213-0691
Mailing Address - Fax:
Practice Address - Street 1:73 LEXINGTON ST
Practice Address - Street 2:STE 202
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02466-1356
Practice Address - Country:US
Practice Address - Phone:617-213-0691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MA10809103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor