Active NPI
Ember Lynn Lee
- Clinical Child & Adolescent Psychologist
- San Diego, CA
National Provider Identifier
1174784144
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- Practice address
- 3665 Kearny Villa Rd
#101
San Diego, CA 92123-1953 - Phone
- (858) 966-5832
- NPI assigned
- Jun 22, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 Child & Adolescent Psychologist | 103TC2200X | Primary |
Addresses
Primary practice location
3665 Kearny Villa Rd
#101
San Diego, CA 92123-1953
Mailing address
4046 1St Ave
#305
San Diego, CA 92103-2036
Phone (334) 707-0380
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 95-1691313 | Other | CA | RADY CHILDREN'S HOSPITAL SAN DIEGO, OUTPATIENT PSYCHIATRY DEPARTMENT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Nov 9, 2023 through Nov 9, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25745 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214092800000",
"number": "1174784144",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4046 1ST AVE",
"address_2": "#305",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921032036",
"telephone_number": "334-707-0380"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3665 KEARNY VILLA RD",
"address_2": "#101",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921231953",
"telephone_number": "858-966-5832"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "EMBER",
"middle_name": "LYNN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-06-22",
"last_updated": "2008-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RADY CHILDREN'S HOSPITAL SAN DIEGO, OUTPATIENT PSYCHIATRY DEPARTMENT",
"identifier": "95-1691313",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.