=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437351129
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROLINE SOOK LEE PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 E SOUTH ST
-----------------------------------------------------
City | HANOVER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03755-2148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-643-6781
-----------------------------------------------------
Fax | 603-643-6782
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 E SOUTH ST
-----------------------------------------------------
City | HANOVER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03755-2148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-643-6781
-----------------------------------------------------
Fax | 603-643-6782
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 1084
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------