Individual
JEANNA RAE LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
279 LINCOLN ST, WORCESTER, MA 01605-2120
(508) 334-8830
(508) 334-8835
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
10023
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110101966A
—
MA
Enumeration date
09/10/2009
Last updated
11/29/2020
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