Basic Information
Provider Information
NPI: 1033557244
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEE
FirstName: ROBERT
MiddleName: LEWIS
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1385 MISSION ST
Address2: #240
City: SAN FRANCISCO
State: CA
PostalCode: 941032623
CountryCode: US
TelephoneNumber: 4158644002
FaxNumber: 4158647093
Practice Location
Address1: 1385 MISSION ST
Address2: #240
City: SAN FRANCISCO
State: CA
PostalCode: 941032623
CountryCode: US
TelephoneNumber: 4158644002
FaxNumber: 4158647093
Other Information
ProviderEnumerationDate: 06/10/2013
LastUpdateDate: 06/10/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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