MEDICARE: DR. WILLIAM VERNON LEE PH.D.

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	103TC0700X	Clinical Psychologist	PSY15905	CA

General Provider Information

NPI Number	:	1063431435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM VERNON LEE PH.D.

Provider Business Mailing Address
First Line	:	582 MARKET ST
Second Line	:	STE 711
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94104-5308
Country	:	US
Telephone Number	:	415-771-1967
Fax Number	:	417-771-1053

Provider Business Practice Location Address
First Line	:	582 MARKET ST
Second Line	:	STE 711
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94104-5308
Country	:	US
Telephone Number	:	415-771-1967
Fax Number	:	417-771-1053

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	08/30/2016

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