Provider Demographics
NPI:1972318608
Name:LEE, WOO CHAN (MFT-LP)
Entity type:Individual
Prefix:
First Name:WOO CHAN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MFT-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E CHESTNUT ST FL 2
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2800
Mailing Address - Country:US
Mailing Address - Phone:315-366-8087
Mailing Address - Fax:
Practice Address - Street 1:111 E CHESTNUT ST FL 2
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2800
Practice Address - Country:US
Practice Address - Phone:315-492-1390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06-P133837-01106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist