Healthcare Provider Details

I. General information

NPI: 1063696466
Provider Name (Legal Business Name): CHASE PSYCHOLOGICAL RESOURCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10721 MAIN ST SUITE 2350
FAIRFAX VA
22030-6914
US

IV. Provider business mailing address

327 CHESTERTOWN ST
GAITHERSBURG MD
20878-5686
US

V. Phone/Fax

Practice location:
  • Phone: 703-591-5912
  • Fax: 703-591-7210
Mailing address:
  • Phone: 301-325-5043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number03341
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810002159
License Number StateVA

VIII. Authorized Official

Name: DR. LEE R CHASE
Title or Position: PSYCHOLOGIST/PRESIDENT
Credential: PH.D.
Phone: 301-325-5043