Healthcare Provider Details

I. General information

NPI: 1154490415
Provider Name (Legal Business Name): LEE GEISEN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 COMMUNITY DR SUITE 306
MANHASSET NY
11030-3820
US

IV. Provider business mailing address

444 COMMUNITY DRIVE SUITE 306
MANHASSET NY
11030-3820
US

V. Phone/Fax

Practice location:
  • Phone: 516-365-6533
  • Fax:
Mailing address:
  • Phone: 516-365-6533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number6614
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number006614
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6614
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number6614
License Number StateNY

VII. Legacy identifiers

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

# 1
Identifier0071646
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerGHI
# 2
Identifier103281000
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerMAGELLAN HEALTH SERVICES
# 3
Identifier01602684
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: