Provider Demographics
NPI:1881619799
Name:SHAIN, LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:SHAIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W 104TH ST
Mailing Address - Street 2:51
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-4220
Mailing Address - Country:US
Mailing Address - Phone:212-974-0005
Mailing Address - Fax:
Practice Address - Street 1:250 W 104TH ST
Practice Address - Street 2:51
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-4220
Practice Address - Country:US
Practice Address - Phone:212-974-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011654103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical