Provider Demographics
NPI:1982299939
Name:ELIZA LEE PHD LLC
Entity Type:Organization
Organization Name:ELIZA LEE PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZA
Authorized Official - Middle Name:CARLSON
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-806-7563
Mailing Address - Street 1:47 WINSLOW HOMER RD
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9480
Mailing Address - Country:US
Mailing Address - Phone:215-806-7563
Mailing Address - Fax:
Practice Address - Street 1:47 WINSLOW HOMER RD
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9480
Practice Address - Country:US
Practice Address - Phone:215-806-7563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)