Provider Demographics
NPI:1457944597
Name:LEE, SEOWOO (EDM)
Entity Type:Individual
Prefix:
First Name:SEOWOO
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:EDM
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:777 6TH AVE APT 22C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6327
Mailing Address - Country:US
Mailing Address - Phone:909-267-5519
Mailing Address - Fax:
Practice Address - Street 1:411 W 114TH ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1710
Practice Address - Country:US
Practice Address - Phone:212-523-7547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist