Provider Demographics
NPI:1386883585
Name:LEE, SOO-IL (PHD, CTRS, LMHC)
Entity type:Individual
Prefix:MR
First Name:SOO-IL
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:PHD, CTRS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-7020
Mailing Address - Country:US
Mailing Address - Phone:516-395-8870
Mailing Address - Fax:
Practice Address - Street 1:321 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5304
Practice Address - Country:US
Practice Address - Phone:718-518-3713
Practice Address - Fax:718-518-3704
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY2603101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health