Provider Demographics
NPI:1720163660
Name:CAGE, LEE E (LCSW)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:E
Last Name:CAGE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17325 TOAKOANA DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8510
Mailing Address - Country:US
Mailing Address - Phone:907-696-1212
Mailing Address - Fax:907-696-1212
Practice Address - Street 1:13135 OLD GLENN HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7562
Practice Address - Country:US
Practice Address - Phone:907-696-1212
Practice Address - Fax:907-696-1212
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK61041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK6OtherAK STATE LICENSE #
AK6OtherAK STATE LICENSE #
AK0000TLCQRMedicare ID - Type UnspecifiedMEDICARE ID