Provider Demographics
NPI:1538599113
Name:LEE, LARRY (BA)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-6002
Mailing Address - Country:US
Mailing Address - Phone:415-971-8611
Mailing Address - Fax:510-380-6122
Practice Address - Street 1:2868 TELEGRAPH AVE
Practice Address - Street 2:UNIT A
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3607
Practice Address - Country:US
Practice Address - Phone:510-500-4124
Practice Address - Fax:510-380-6122
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst