Provider Demographics
NPI:1174624449
Name:LEE, KIRSTEN SUE (LMFT)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:SUE
Last Name:LEE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LADD ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4087
Mailing Address - Country:US
Mailing Address - Phone:603-431-8800
Mailing Address - Fax:603-433-6341
Practice Address - Street 1:20 LADD ST
Practice Address - Street 2:SUITE 410
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4087
Practice Address - Country:US
Practice Address - Phone:603-431-8800
Practice Address - Fax:603-433-6341
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH46106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1404258Y0NH02OtherANTHEM BC/BS
NH30423977Medicaid
ME061671OtherANTHEM BC/BS