Provider Demographics
NPI:1952937229
Name:LEE, RENEE YVONNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:YVONNE
Last Name:LEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:RENEE
Other - Middle Name:YVONNE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4550 W 103RD ST STE 302B
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4868
Mailing Address - Country:US
Mailing Address - Phone:773-280-5675
Mailing Address - Fax:773-873-5333
Practice Address - Street 1:4550 W 103RD ST STE 302B
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4868
Practice Address - Country:US
Practice Address - Phone:773-280-5675
Practice Address - Fax:773-873-5333
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490205631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty