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Individual

MR. KERRY LEE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCSW, LADC

Contact information

Practice address
40 BROADWAY, NORWICH, CT 06360-5702
(860) 887-6536
(860) 885-1970
Mailing address
40 BROADWAY, NORWICH, CT 06360-5702
(860) 887-6536
(860) 885-1970

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
000817
CT
1041C0700X
Clinical Social Worker
Primary
006353
CT

Other

Enumeration date
02/23/2012
Last updated
02/23/2012
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