Healthcare Provider Details

I. General information

NPI: 1366989162
Provider Name (Legal Business Name): MAEDINE LUCY YEE LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 GROVER LN
EAST NORTHPORT NY
11731-3628
US

IV. Provider business mailing address

68 GROVER LN
EAST NORTHPORT NY
11731-3628
US

V. Phone/Fax

Practice location:
  • Phone: 631-645-5332
  • Fax:
Mailing address:
  • Phone: 631-645-5332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR055082
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: