Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 35SI00250900 | NJ |
N | 103T00000X | Psychologist | 35SI00250900 | NJ |
N | 103TA0700X | Adult Development & Aging Psychologist | ||
Y | 103G00000X | Clinical Psychologist | 35SI00250900 | NJ |
Y | 103TC0700X | Clinical Psychologist | 35SI00250900 | NJ |
N | 103TH0004X | Health Psychologist |
NPI | 1750904090 |
---|---|
Provider Name | Sandra S. Lee |
First Address | West Orange, NJ 07052-4136 |
Second Address | West Orange, NJ 07052-4136 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2020 |
Last Update Date | 21/05/2020 |