MEDICARE: JESSICA N. LEE

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	101YM0800X	Mental Health Counselor	261191	MA

General Provider Information

NPI Number	:	1417479551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA N. LEE

Provider Business Mailing Address
First Line	:	1290 TREMONT ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02120-3432
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	790 TURNPIKE ST STE 303
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-6129
Country	:	US
Telephone Number	:	781-797-0465
Fax Number	:

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

Provider Enumeration Date	:	07/11/2017
Last Update Date	:	11/02/2022

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