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NPI Code Detail

MEDICARE: MS. AMANDA STEPHANIE LEE LCSW

MEDICARE:  MS. AMANDA STEPHANIE LEE  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
11041C0700XClinical Social Worker74719CA

General Provider Information

NPI Number : 1740409432
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMANDA STEPHANIE LEE LCSW
Provider Business Mailing Address
First Line : 2208 RIVER RUN DR UNIT 56
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-5810
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2208 RIVER RUN DR UNIT 56
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-5810
Country : US
Telephone Number : 951-760-3882
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2007
Last Update Date : 02/01/2023

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Directions to “ MS. AMANDA STEPHANIE LEE LCSW” Practice Location

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