MEDICARE: JEREMY LINN LEES MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	44SL06222000	NJ
2	1041C0700X	Clinical Social Worker	44SC05961100	NJ

General Provider Information

NPI Number	:	1225526411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY LINN LEES MSW, LCSW

Provider Business Mailing Address
First Line	:	200 WHITE RD STE 208
Second Line	:
City	:	LITTLE SILVER
State	:	NJ
Zip	:	07739-1162
Country	:	US
Telephone Number	:	732-945-6771
Fax Number	:	732-842-1794

Provider Business Practice Location Address
First Line	:	200 WHITE RD STE 208
Second Line	:
City	:	LITTLE SILVER
State	:	NJ
Zip	:	07739-1162
Country	:	US
Telephone Number	:	732-945-6771
Fax Number	:	732-842-1794

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2018
Last Update Date	:	11/15/2022

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