MEDICARE: VINCENT LEE AMFT

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	106H00000X	Marriage & Family Therapist	133668	CA

General Provider Information

NPI Number	:	1316650567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT LEE AMFT

Provider Business Mailing Address
First Line	:	2401 23RD AVE APT 5
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94116-2438
Country	:	US
Telephone Number	:	415-351-9298
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 FASHION ISLAND BLVD STE 110
Second Line	:
City	:	FOSTER CITY
State	:	CA
Zip	:	94404-5043
Country	:	US
Telephone Number	:	650-570-7273
Fax Number	:

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

Provider Enumeration Date	:	01/03/2023
Last Update Date	:	01/03/2023

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