Provider Demographics
NPI:1730757154
Name:LEE, FELICITY LILLIAN (LSW)
Entity type:Individual
Prefix:
First Name:FELICITY
Middle Name:LILLIAN
Last Name:LEE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3533 SLEEPY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-4156
Mailing Address - Country:US
Mailing Address - Phone:208-901-0863
Mailing Address - Fax:
Practice Address - Street 1:799 N COURT ST STE 11
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1766
Practice Address - Country:US
Practice Address - Phone:419-575-1978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-13
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
S.20051201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1041C0700XMedicaid