MEDICARE: MR. PAUL PATRICK LEE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	1065	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1065	OTHER		OREGON BOARD OF CLINICAL SOCIAL WORKERS

General Provider Information

NPI Number	:	1003126772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL PATRICK LEE LCSW

Provider Business Mailing Address
First Line	:	12 SE 14TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-1404
Country	:	US
Telephone Number	:	503-235-3433
Fax Number	:	503-235-4762

Provider Business Practice Location Address
First Line	:	12 SE 14TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-1404
Country	:	US
Telephone Number	:	503-235-3433
Fax Number	:	503-235-4762

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2010
Last Update Date	:	10/15/2010

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