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General NPI Number Information
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NPI Number | 1821819863
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Entity Type | Individual
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Provider Name | JENNA JAEYEON LEE
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Gender | Female
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Dates
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Enumeration Date | 10/22/2024
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 4216 162ND ST APT 2
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City | FLUSHING
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State | NY
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Zip | 11358-4155
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Country | US
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Telephone | 646-643-1550
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Fax |
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Provider Business Mailing Address
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Address Line | 1545 BELL BLVD APT 2
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City | BAYSIDE
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State | NY
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Zip | 11360-1234
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Country | US
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Telephone | 646-643-1550
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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 | P131697
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License Number State | NY
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