Provider Demographics
NPI:1285703181
Name:SHUSTER, LEE S (LISW, LCSW)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:S
Last Name:SHUSTER
Suffix:
Gender:F
Credentials:LISW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 ASHLEY LN
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-8923
Mailing Address - Country:US
Mailing Address - Phone:505-850-2684
Mailing Address - Fax:505-899-4306
Practice Address - Street 1:4313 CORRALES RD
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-8663
Practice Address - Country:US
Practice Address - Phone:505-850-2684
Practice Address - Fax:505-899-4306
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX368701041C0700X
NMI-079391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical