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NPI Code Detail

MEDICARE: DOMINIQUE N LEE

MEDICARE: DOMINIQUE N LEE
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
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1588502959
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOMINIQUE N LEE
Provider Business Mailing Address
First Line : 25 RUGBY RD
Second Line :
City : MATTAPAN
State : MA
Zip : 02126-3227
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 105 VICTORY RD
Second Line :
City : DORCHESTER
State : MA
Zip : 02122-3518
Country : US
Telephone Number : 617-371-3010
Fax Number : 617-371-3044
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2026
Last Update Date : 03/24/2026

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