MEDICARE: EUNWOO LEE LMSW

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	086918-01	NY

General Provider Information

NPI Number	:	1902553951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUNWOO LEE LMSW

Provider Business Mailing Address
First Line	:	3 NIBLOCK CT FL 2
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12206-1405
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 NIBLOCK CT FL 2
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12206-1405
Country	:	US
Telephone Number	:	267-736-9010
Fax Number	:

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

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	03/09/2022

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Directions to “ EUNWOO LEE LMSW” Practice Location

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