Provider Demographics
NPI:1831081256
Name:LEE, TONY
Entity type:Individual
Prefix:MR
First Name:TONY
Middle Name:
Last Name:LEE
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 61ST ST APT 12D
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-5745
Mailing Address - Country:US
Mailing Address - Phone:646-831-5799
Mailing Address - Fax:929-424-3371
Practice Address - Street 1:4730 61ST ST APT 12D
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-5745
Practice Address - Country:US
Practice Address - Phone:646-831-5799
Practice Address - Fax:929-424-3371
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty