Provider Demographics
NPI:1982911764
Name:LEE-ISA, CARROL ELANE (MS, LCSW)
Entity Type:Individual
Prefix:
First Name:CARROL
Middle Name:ELANE
Last Name:LEE-ISA
Suffix:
Gender:F
Credentials:MS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 MEEKER RD
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2058
Mailing Address - Country:US
Mailing Address - Phone:908-612-1324
Mailing Address - Fax:
Practice Address - Street 1:116 MEEKER RD
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-2058
Practice Address - Country:US
Practice Address - Phone:908-612-1324
Practice Address - Fax:908-612-1324
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001571001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical