MEDICARE: DR. LAURENCE RAYMOND LEVINE PSY.D.

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	03100	MD

General Provider Information

NPI Number	:	1871745844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURENCE RAYMOND LEVINE PSY.D.

Provider Business Mailing Address
First Line	:	9121 ORCHARD BROOK DR
Second Line	:
City	:	POTOMAC
State	:	MD
Zip	:	20854-2404
Country	:	US
Telephone Number	:	240-393-3986
Fax Number	:	301-610-0464

Provider Business Practice Location Address
First Line	:	9121 ORCHARD BROOK DR
Second Line	:
City	:	POTOMAC
State	:	MD
Zip	:	20854-2404
Country	:	US
Telephone Number	:	240-393-3986
Fax Number	:	301-610-0464

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

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	10/21/2008

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