Healthcare Provider Details

I. General information

NPI: 1982911764
Provider Name (Legal Business Name): CARROL ELANE LEE-ISA M.S., LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MEEKER RD
BASKING RIDGE NJ
07920-2058
US

IV. Provider business mailing address

116 MEEKER RD
BASKING RIDGE NJ
07920-2058
US

V. Phone/Fax

Practice location:
  • Phone: 908-612-1324
  • Fax: 908-612-1324
Mailing address:
  • Phone: 908-612-1324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00157100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: