Provider Demographics
NPI:1548070428
Name:KERRY LEE LCSW LLC
Entity type:Organization
Organization Name:KERRY LEE LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-867-0311
Mailing Address - Street 1:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:SCOTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06264-0183
Mailing Address - Country:US
Mailing Address - Phone:860-867-0311
Mailing Address - Fax:
Practice Address - Street 1:8 W MAIN ST STE 3-11
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-2332
Practice Address - Country:US
Practice Address - Phone:860-867-0311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health