Healthcare Provider Details

I. General information

NPI: 1922146075
Provider Name (Legal Business Name): YOONJIN JEE LCSW, CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 E VIEW CT
JERICHO NY
11753
US

IV. Provider business mailing address

42 E VIEW CT
JERICHO NY
11753
US

V. Phone/Fax

Practice location:
  • Phone: 917-744-1569
  • Fax: 516-719-0459
Mailing address:
  • Phone: 917-744-1569
  • Fax: 516-719-0459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number18191
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number061347-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier076166-1
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerLCSW

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: