Provider Demographics
NPI:1811175383
Name:LEE, EMILY NICOLE (MSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:NICOLE
Last Name:LEE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:NICOLE
Other - Last Name:WIDENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5544 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-9731
Mailing Address - Country:US
Mailing Address - Phone:317-753-2422
Mailing Address - Fax:
Practice Address - Street 1:5544 WATSON RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-9731
Practice Address - Country:US
Practice Address - Phone:317-753-2422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor