Provider Demographics
NPI:1174776074
Name:MELTZER, LEE RICHARD (LP)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:RICHARD
Last Name:MELTZER
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LAMPLIGHT ST
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-1465
Mailing Address - Country:US
Mailing Address - Phone:516-817-0780
Mailing Address - Fax:419-728-9699
Practice Address - Street 1:19 W 34TH ST PH
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:646-600-8251
Practice Address - Fax:419-728-9699
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000449102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst