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General NPI Number Information
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NPI Number | 1821693482
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Entity Type | Individual
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Provider Name | ROBERT T LEE II RCSWI
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Gender | Male
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Dates
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Enumeration Date | 12/02/2020
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | 105 S RIVERSIDE DR STE 122
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City | INDIALANTIC
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State | FL
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Zip | 32903-4321
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Country | US
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Telephone | 321-506-4224
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Fax |
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Provider Business Mailing Address
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Address Line | 409 5TH AVE
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City | MELBOURNE BEACH
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State | FL
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Zip | 32951-2603
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Country | US
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Telephone | 321-506-4224
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | ISW13431
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ISW13431
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License Number State | FL
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