MEDICARE: SO YOUNG 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	076154	NY

General Provider Information

NPI Number	:	1679045652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SO YOUNG LEE LCSW

Provider Business Mailing Address
First Line	:	100 OLD PALISADE RD APT 606
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-7013
Country	:	US
Telephone Number	:	347-228-3475
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 OLD PALISADE RD APT 606
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-7013
Country	:	US
Telephone Number	:	347-228-3475
Fax Number	:

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

Provider Enumeration Date	:	01/01/2019
Last Update Date	:	01/01/2019

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Directions to “ SO YOUNG LEE LCSW” Practice Location

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