MEDICARE: ROBERT T LEE II RCSWI

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	ISW13431	FL
2	101YM0800X	Mental Health Counselor	ISW13431	FL

General Provider Information

NPI Number	:	1821693482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT T LEE II RCSWI

Provider Business Mailing Address
First Line	:	409 5TH AVE
Second Line	:
City	:	MELBOURNE BEACH
State	:	FL
Zip	:	32951-2603
Country	:	US
Telephone Number	:	321-506-4224
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 S RIVERSIDE DR STE 122
Second Line	:
City	:	INDIALANTIC
State	:	FL
Zip	:	32903-4321
Country	:	US
Telephone Number	:	321-506-4224
Fax Number	:

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

Provider Enumeration Date	:	12/02/2020
Last Update Date	:	12/02/2020

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