MEDICARE: DR. BARBARA D LEE PSY.D.

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	103TC0700X	Clinical Psychologist	1125	HI

General Provider Information

NPI Number	:	1962736959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA D LEE PSY.D.

Provider Business Mailing Address
First Line	:	430 KAHA ST
Second Line	:
City	:	KAILUA
State	:	HI
Zip	:	96734-2002
Country	:	US
Telephone Number	:	808-255-9449
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 S BERETANIA ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96826-1932
Country	:	US
Telephone Number	:	808-255-9449
Fax Number	:

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

Provider Enumeration Date	:	09/24/2009
Last Update Date	:	09/24/2009

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