Healthcare Provider Details

I. General information

NPI: 1780668673
Provider Name (Legal Business Name): SUSAN LEE HYCHE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2005
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VAMHCS PERRY POINT DIVISION BLDG 364
PERRY POINT MD
21902
US

IV. Provider business mailing address

VAMHCS - PERRY POINT DIVISION BLDG 364B
PERRY POINT MD
21902
US

V. Phone/Fax

Practice location:
  • Phone: 410-642-2411
  • Fax:
Mailing address:
  • Phone: 410-642-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2429
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: