Provider Demographics
NPI:1538257126
Name:LEE, LAURA A (LMHC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:A
Last Name:LEE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 PLAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02379-1338
Mailing Address - Country:US
Mailing Address - Phone:508-436-0273
Mailing Address - Fax:
Practice Address - Street 1:185 MAIN ST
Practice Address - Street 2:SUITE 28
Practice Address - City:AVON
Practice Address - State:MA
Practice Address - Zip Code:02322-1452
Practice Address - Country:US
Practice Address - Phone:508-436-0273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5413101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM1303OtherBCBSMA