MEDICARE: JUSTINE LASSMAN PSYD

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1831380922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTINE LASSMAN PSYD

Provider Business Mailing Address
First Line	:	1350 CONNECTICUT AVE NW STE 604
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20036-1735
Country	:	US
Telephone Number	:	202-922-6989
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 CONNECTICUT AVE NW STE 604
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20036-1735
Country	:	US
Telephone Number	:	202-922-6989
Fax Number	:

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

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	03/25/2020

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