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NPI Code Detail

MEDICARE: TERRAINE LEE 18145

MEDICARE: TERRAINE LEE 18145
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
1101YA0400XAddiction (Substance Use Disorder) Counselor18145NY

General Provider Information

NPI Number : 1275985871
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRAINE LEE 18145
Provider Business Mailing Address
First Line : 18 VARICK HOMES
Second Line :
City : NEWBURGH
State : NY
Zip : 12550-4660
Country : US
Telephone Number : 845-561-5783
Fax Number : 845-561-0243
Provider Business Practice Location Address
First Line : 172 LIBERTY ST
Second Line :
City : NEWBURGH
State : NY
Zip : 12550-4912
Country : US
Telephone Number : 845-561-5783
Fax Number : 845-561-5783
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2016
Last Update Date : 07/07/2016

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