MEDICARE: JESSICA YOOKYUNG 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	117474	CA

General Provider Information

NPI Number	:	1336999671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA YOOKYUNG LEE LCSW

Provider Business Mailing Address
First Line	:	14535 DICKENS ST
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-3761
Country	:	US
Telephone Number	:	949-233-1862
Fax Number	:

Provider Business Practice Location Address
First Line	:	14535 DICKENS ST
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-3761
Country	:	US
Telephone Number	:	949-233-1862
Fax Number	:

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

Provider Enumeration Date	:	03/26/2024
Last Update Date	:	03/26/2024

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