Provider Demographics
NPI:1194914366
Name:LEE, JUDY (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:LEE-NORMANDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:184 ELDRIDGE ST
Mailing Address - Street 2:CONSULTATION CENTER
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-2924
Mailing Address - Country:US
Mailing Address - Phone:212-453-4522
Mailing Address - Fax:212-253-6527
Practice Address - Street 1:184 ELDRIDGE ST
Practice Address - Street 2:CONSULTATION CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-2924
Practice Address - Country:US
Practice Address - Phone:212-453-4522
Practice Address - Fax:212-253-6527
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR048230-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR048230-1OtherLCSW
NYNV5971Medicare UPIN