Healthcare Provider Details

I. General information

NPI: 1992067052
Provider Name (Legal Business Name): LYNNE B. HAZARD, PH.D. & ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 EXECUTIVE BLVD
ROCKVILLE MD
20852-3906
US

IV. Provider business mailing address

6201 EXECUTIVE BLVD
ROCKVILLE MD
20852-3906
US

V. Phone/Fax

Practice location:
  • Phone: 301-770-2847
  • Fax:
Mailing address:
  • Phone: 301-770-2847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1580
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number02129
License Number StateMD

VIII. Authorized Official

Name: DR. LYNNE B. HAZARD
Title or Position: PRESIDENT/PSYCHOLOGIST
Credential: PH.D.
Phone: 301-770-2847