Provider Demographics
NPI:1992396477
Name:LEE, LISA R (MED)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:LEE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-1510
Mailing Address - Country:US
Mailing Address - Phone:617-291-4433
Mailing Address - Fax:
Practice Address - Street 1:BAY COVE UCC
Practice Address - Street 2:85 E NEWTON STREET
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-414-8337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor