Provider Demographics
NPI:1396945721
Name:LEE, JIN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JIN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ANDREW
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:8 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2144
Mailing Address - Country:US
Mailing Address - Phone:973-224-5661
Mailing Address - Fax:
Practice Address - Street 1:29 ROUTE 34 N
Practice Address - Street 2:COLTS NECK CONSULTING GROUP
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-1555
Practice Address - Country:US
Practice Address - Phone:732-780-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTP043-443103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist