Healthcare Provider Details

I. General information

NPI: 1770634925
Provider Name (Legal Business Name): LORI A LEFCOURT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 M ST NW SUITE 429
WASHINGTON DC
20037-1404
US

IV. Provider business mailing address

1326 MURRAY DOWNS WAY
RESTON VA
20194-1435
US

V. Phone/Fax

Practice location:
  • Phone: 703-582-4328
  • Fax:
Mailing address:
  • Phone: 703-582-4328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY1853
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: