Basic Information
Provider Information
NPI: 1003001165
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GOLDSTEIN
FirstName: LEE
MiddleName: EDWIN
NamePrefix: DR.
NameSuffix:  
Credential: M.D., PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 670 ALBANY ST
Address2:  
City: BOSTON
State: MA
PostalCode: 021182646
CountryCode: US
TelephoneNumber: 6174148361
FaxNumber: 6174147073
Practice Location
Address1: 670 ALBANY ST
Address2:  
City: BOSTON
State: MA
PostalCode: 021182646
CountryCode: US
TelephoneNumber: 6174148361
FaxNumber: 6174147073
Other Information
ProviderEnumerationDate: 09/12/2007
LastUpdateDate: 07/30/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800X152962MAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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