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NPI Code Detail

MEDICARE: ANDREI LEE LCSW

MEDICARE: ANDREI 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
11041C0700XClinical Social Worker099118NY

General Provider Information

NPI Number : 1700508439
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREI LEE LCSW
Provider Business Mailing Address
First Line : 79 MIDDLEVILLE RD
Second Line :
City : NORTHPORT
State : NY
Zip : 11768-2200
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 79 MIDDLEVILLE RD
Second Line :
City : NORTHPORT
State : NY
Zip : 11768-2200
Country : US
Telephone Number : 631-261-4400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2022
Last Update Date : 03/24/2026

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