Active NPI
Carolyn Louise Lee, PH.D., ABPP
- Clinical Psychologist
- Bloomington, IN
National Provider Identifier
1003943762
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 20010501
- Practice address
- 600 N Jordan Ave
Bloomington, IN 47405-3190 - Phone
- (812) 855-5711
- NPI assigned
- Feb 28, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 20010501 | IN | Primary |
Addresses
Primary practice location
600 N Jordan Ave
Bloomington, IN 47405-3190
Mailing address
600 N Jordan Ave
Bloomington, IN 47405-3190
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20010501 | IN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189468800000",
"number": "1003943762",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 N JORDAN AVE",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474053190"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 N JORDAN AVE",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474053190",
"telephone_number": "812-855-5711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "CAROLYN",
"middle_name": "LOUISE",
"name_prefix": "Dr.",
"credential": "PH.D., ABPP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-28",
"last_updated": "2007-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IN",
"license": "20010501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.