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Individual
MS. SUSAN DIANE LEE
Active
Individual
MS. SUSAN DIANE LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
34003900A
IN
1041C0700X
Clinical Social Worker
Primary
C009372
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000341222
ANTHEM
IN
05
—
200475040
—
IN
01
—
708536000
MAGELLAN
IN
01
—
7112740
AETNA
IN
Enumeration date
11/20/2006
Last updated
12/27/2021
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