Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | I.1100063 | OH |
NPI | 1003153123 |
---|---|
Provider Name | Mr. Roger Arnold Lee |
First Address | Greenville, OH 45331-1913 |
Second Address | Greenville, OH 45331-1913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2013 |
Last Update Date | 15/01/2013 |