Provider Demographics
NPI:1255701975
Name:LEE, CAMERON (LCSW 114220)
Entity type:Individual
Prefix:MR
First Name:CAMERON
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:LCSW 114220
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 N GRAMERCY PL APT 18
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-5809
Mailing Address - Country:US
Mailing Address - Phone:714-334-3415
Mailing Address - Fax:
Practice Address - Street 1:1824 N GRAMERCY PL APT 18
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-5809
Practice Address - Country:US
Practice Address - Phone:714-334-3415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1142201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical