Healthcare Provider Details

I. General information

NPI: 1538576665
Provider Name (Legal Business Name): DANA LEE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4161 CARMICHAEL AVE STE 150
JACKSONVILLE FL
32207-2349
US

IV. Provider business mailing address

6111 MAGGIES CIR UNIT 101
JACKSONVILLE FL
32244-8528
US

V. Phone/Fax

Practice location:
  • Phone: 904-396-8750
  • Fax:
Mailing address:
  • Phone: 725-275-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05742500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: