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General NPI Number Information
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NPI Number | 1285102236
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Entity Type | Individual
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Provider Name | REBECCA LEE LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/07/2018
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Last Update Date | 05/06/2022
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Provider Practice Location Address
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Address Line | 950 DANBY RD STE 129
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City | ITHACA
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State | NY
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Zip | 14850-5731
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Country | US
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Telephone | 612-226-5902
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Fax |
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Provider Business Mailing Address
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Address Line | 213 TIOGA ST UNIT 6883
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City | ITHACA
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State | NY
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Zip | 14851-8070
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Country | US
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Telephone | 612-226-5902
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 097848
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 093314
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License Number State | NY
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