Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | LPES 3090 | SC |
NPI | 1033150255 |
---|---|
Provider Name | Lee Neulicht |
First Address | Monroe, NC 28112-8290 |
Second Address | Monroe, NC 28112-8290 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
WP9909 | (05) | SC |