Provider Demographics
NPI:1083193205
Name:LEE, EUN JU (PSYD)
Entity type:Individual
Prefix:DR
First Name:EUN JU
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 SUPERIOR AVE E
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-4166
Mailing Address - Country:US
Mailing Address - Phone:216-361-1223
Mailing Address - Fax:216-361-1568
Practice Address - Street 1:3820 SUPERIOR AVE E
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-4166
Practice Address - Country:US
Practice Address - Phone:216-361-1223
Practice Address - Fax:216-361-1568
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health