MEDICARE: MARISSA LEE LMHC

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1386951986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA LEE LMHC

Provider Business Mailing Address
First Line	:	PO BOX 754195
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-9195
Country	:	US
Telephone Number	:	917-408-3981
Fax Number	:

Provider Business Practice Location Address
First Line	:	10209 METROPOLITAN AVE FL 2
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-6731
Country	:	US
Telephone Number	:	917-408-3981
Fax Number	:

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

Provider Enumeration Date	:	09/03/2010
Last Update Date	:	08/23/2019

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