Provider Demographics
NPI:1942081815
Name:LEE, KI YEON (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:KI
Middle Name:YEON
Last Name:LEE
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:KI YEON
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4275 MURRAY ST FL 1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-1324
Mailing Address - Country:US
Mailing Address - Phone:631-617-2009
Mailing Address - Fax:
Practice Address - Street 1:333 EARLE OVINGTON BLVD STE 600
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3622
Practice Address - Country:US
Practice Address - Phone:516-621-2681
Practice Address - Fax:516-621-2403
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003149103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst