Healthcare Provider Details

I. General information

NPI: 1497388706
Provider Name (Legal Business Name): CLARICE ANGELICA LEE MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2020
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5896 SW 66TH ST APT 12
SOUTH MIAMI FL
33143-3601
US

IV. Provider business mailing address

5896 SW 66TH ST APT 12
SOUTH MIAMI FL
33143-3601
US

V. Phone/Fax

Practice location:
  • Phone: 727-793-4821
  • Fax:
Mailing address:
  • Phone: 727-793-4821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License NumberL000101958260
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: