Basic Information
| Provider Information | |||||||||
| NPI: | 1083097323 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | CASEY | ||||||||
| MiddleName: | MCCAFFREY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10040 HIGHWAY 9 | ||||||||
| Address2: | APT 1 | ||||||||
| City: | BEN LOMOND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950059248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8318181189 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12 CARR ST | ||||||||
| Address2: | |||||||||
| City: | WATSONVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950764710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317688132 | ||||||||
| FaxNumber: | 8317687593 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2015 | ||||||||
| LastUpdateDate: | 07/15/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | CA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.