Healthcare Provider Details

I. General information

NPI: 1639298433
Provider Name (Legal Business Name): BETSY ELLEN LAWRENCE PH. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7629 CABIN RD
CABIN JOHN MD
20818-1406
US

IV. Provider business mailing address

7629 CABIN RD
CABIN JOHN MD
20818-1406
US

V. Phone/Fax

Practice location:
  • Phone: 301-229-6706
  • Fax: 301-229-9168
Mailing address:
  • Phone: 301-229-6706
  • Fax: 301-229-9168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberDC791
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number01015
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: