Individual
JIEUN LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 856-6580
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
9399
MA
Other
Enumeration date
08/27/2010
Last updated
10/18/2011
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