Provider Demographics
NPI:1982616876
Name:LEE, DANIEL E (PSYD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:LEE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 WEAVER PKWY STE 100A
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-3920
Mailing Address - Country:US
Mailing Address - Phone:630-416-8289
Mailing Address - Fax:630-416-8306
Practice Address - Street 1:4300 WEAVER PKWY STE 100A
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3920
Practice Address - Country:US
Practice Address - Phone:630-416-8289
Practice Address - Fax:630-416-8306
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003385101YM0800X
IL071-010363103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health