Provider Demographics
NPI:1821885260
Name:LEE, MINSUN MICHELLE (PHD)
Entity type:Individual
Prefix:
First Name:MINSUN
Middle Name:MICHELLE
Last Name:LEE
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 VICTORIA LN # 2
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-5315
Mailing Address - Country:US
Mailing Address - Phone:215-316-0935
Mailing Address - Fax:
Practice Address - Street 1:160 CONVENT AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-9101
Practice Address - Country:US
Practice Address - Phone:212-650-7752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027061103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical