Provider Demographics
NPI:1144500521
Name:LEE, JANE PEARL (LCSW)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:PEARL
Last Name:LEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17632 IRVINE BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3148
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17632 IRVINE BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3148
Practice Address - Country:US
Practice Address - Phone:951-323-2581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA268961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical