Provider Demographics
NPI:1699934950
Name:LEE, CHARLES R (EDD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:LEE
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 PLEASANT AVENUE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45015
Mailing Address - Country:US
Mailing Address - Phone:513-868-1562
Mailing Address - Fax:513-868-1415
Practice Address - Street 1:2100 PLEASANT AVENUE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45015
Practice Address - Country:US
Practice Address - Phone:513-868-1562
Practice Address - Fax:513-868-1415
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3582103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3582OtherPSY