Provider Demographics
NPI:1013466655
Name:LEE, JESSAMYNE
Entity Type:Individual
Prefix:
First Name:JESSAMYNE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 TREMONT ST
Mailing Address - Street 2:APT B417
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-5041
Mailing Address - Country:US
Mailing Address - Phone:267-721-0902
Mailing Address - Fax:
Practice Address - Street 1:2201 TREMONT ST
Practice Address - Street 2:APT B417
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19115-5041
Practice Address - Country:US
Practice Address - Phone:267-721-0902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health