Healthcare Provider Details

I. General information

NPI: 1275467615
Provider Name (Legal Business Name): ERIC CHARLES LEE LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HIGH RIDGE RD
STAMFORD CT
06905-1223
US

IV. Provider business mailing address

1200 HIGH RIDGE RD
STAMFORD CT
06905-1223
US

V. Phone/Fax

Practice location:
  • Phone: 203-208-6072
  • Fax: 203-951-6402
Mailing address:
  • Phone: 203-208-6072
  • Fax: 203-951-6402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12280
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: