Provider Demographics
NPI:1457128027
Name:LEE, JIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JIN
Middle Name:
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 1:2819 33RD ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1303
Mailing Address - Country:US
Mailing Address - Phone:718-216-8310
Mailing Address - Fax:
Practice Address - Street 1:2819 33RD ST APT 2C
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1303
Practice Address - Country:US
Practice Address - Phone:718-216-8310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026186103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist