Healthcare Provider Details

I. General information

NPI: 1427203223
Provider Name (Legal Business Name): DANIEL A LEE PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 S DON ROSER DR
LAS CRUCES NM
88011-4550
US

IV. Provider business mailing address

6327 BURBRIDGE ST
PHILADELPHIA PA
19144-2505
US

V. Phone/Fax

Practice location:
  • Phone: 575-636-2506
  • Fax: 575-288-2691
Mailing address:
  • Phone: 267-259-4558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberPSY20250123
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY20240077
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number578485
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number10641367
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS016044
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI00461200
License Number StateNJ
# 7
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberB10000996
License Number StateDE
# 8
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number429721
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: