Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 9692 | MA |
N | 103TC0700X | Clinical Psychologist | 9692 | MA |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 9692 | MA |
NPI | 1104023449 |
---|---|
Provider Name | Dr. Aileen Lee |
First Address | Quincy, MA 02169-7482 |
Second Address | Quincy, MA 02169-7482 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 19/05/2013 |