Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 022457 | NY |
N | 103TC0700X | Clinical Psychologist | 022457 | NY |
N | 102L00000X | Psychologist | 022457 | NY |
N | 103T00000X | Psychologist | 022457 | NY |
N | 103TA0700X | Adult Development & Aging Psychologist | 022457 | NY |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 022457 | NY |
Y | 103G00000X | Clinical Psychologist | 022457 | NY |
Y | 103TC0700X | Clinical Psychologist | 022457 | NY |
N | 103TC1900X | Counseling Psychologist | 022457 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 022457 | NY |
N | 103TF0000X | Family Psychologist | 022457 | NY |
N | 103TR0400X | Rehabilitation Psychologist | 022457 | NY |
NPI | 1043718505 |
---|---|
Provider Name | Elsa Lee |
First Address | Little Neck, NY 11362-1451 |
Second Address | Little Neck, NY 11362-1451 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2018 |
Last Update Date | 02/01/2020 |