Provider Demographics
NPI:1285741025
Name:LEE, MAURICE PARK (MD, PHD)
Entity type:Individual
Prefix:
First Name:MAURICE
Middle Name:PARK
Last Name:LEE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:UCHC/CMHC-GAR
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-7601
Mailing Address - Country:US
Mailing Address - Phone:203-270-2800
Mailing Address - Fax:203-270-1826
Practice Address - Street 1:50 NUNNAWAUK RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-2319
Practice Address - Country:US
Practice Address - Phone:203-270-2800
Practice Address - Fax:203-270-1826
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0432362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTI57695Medicare UPIN