MEDICARE: DR. BRYCE EDWIN LEFEVER PH.D. ABPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	081003119	VA

General Provider Information

NPI Number	:	1205800620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYCE EDWIN LEFEVER PH.D. ABPP

Provider Business Mailing Address
First Line	:	PO BOX 1595
Second Line	:
City	:	MIDDLETOWN
State	:	CT
Zip	:	06457-8095
Country	:	US
Telephone Number	:	717-272-5464
Fax Number	:	717-273-1416

Provider Business Practice Location Address
First Line	:	5400 BIG TYLER RD # D
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25313-1178
Country	:	US
Telephone Number	:	717-848-6116
Fax Number	:	717-852-7580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	05/28/2024

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