Healthcare Provider Details

I. General information

NPI: 1841374964
Provider Name (Legal Business Name): GEORGE LEE CAREY III MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6666 PASSER RD STE 2
COOPERSBURG PA
18036-1258
US

IV. Provider business mailing address

6666 PASSER RD STE 2
COOPERSBURG PA
18036-1258
US

V. Phone/Fax

Practice location:
  • Phone: 484-353-6544
  • Fax: 215-536-8523
Mailing address:
  • Phone: 484-353-6544
  • Fax: 215-536-8523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS005963L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: