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NPI Code Detail

MEDICARE: DR. DEBRA LOU ANDERSON PHD

MEDICARE: DR. DEBRA LOU ANDERSON PHD
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
1103T00000XPsychologist1650CO
2103T00000XPsychologist04665MD

General Provider Information

NPI Number : 1619066107
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEBRA LOU ANDERSON PHD
Provider Business Mailing Address
First Line : 20007 HOFFSTEAD LN
Second Line :
City : MONTGOMERY VILLAGE
State : MD
Zip : 20886-1431
Country : US
Telephone Number : 720-260-2544
Fax Number : 240-238-6143
Provider Business Practice Location Address
First Line : 15817 CRABBS BRANCH WAY
Second Line :
City : DERWOOD
State : MD
Zip : 20855-6613
Country : US
Telephone Number : 301-948-2280
Fax Number : 301-972-0095
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 06/10/2024

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