Provider Demographics
NPI:1194059154
Name:HENRY, LEE DORIC (ME, ATR)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:DORIC
Last Name:HENRY
Suffix:
Gender:F
Credentials:ME, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1729
Mailing Address - Country:US
Mailing Address - Phone:978-459-2306
Mailing Address - Fax:978-453-9394
Practice Address - Street 1:45 MERRIMACK ST
Practice Address - Street 2:200
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1729
Practice Address - Country:US
Practice Address - Phone:978-459-2306
Practice Address - Fax:978-453-9394
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist