MEDICARE: GREGORY 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	149016873	IL

General Provider Information

NPI Number	:	1427761113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY LEE LCSW

Provider Business Mailing Address
First Line	:	479 N HARLEM AVE APT 1114
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60301-6415
Country	:	US
Telephone Number	:	708-683-0101
Fax Number	:

Provider Business Practice Location Address
First Line	:	479 N HARLEM AVE APT 1114
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60301-6415
Country	:	US
Telephone Number	:	708-683-0101
Fax Number	:

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

Provider Enumeration Date	:	12/28/2022
Last Update Date	:	12/28/2022

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