Healthcare Provider Details

I. General information

NPI: 1205800620
Provider Name (Legal Business Name): BRYCE EDWIN LEFEVER PH.D. ABPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 BIG TYLER RD # D
CHARLESTON WV
25313-1178
US

IV. Provider business mailing address

PO BOX 1595
MIDDLETOWN CT
06457-8095
US

V. Phone/Fax

Practice location:
  • Phone: 717-848-6116
  • Fax: 717-852-7580
Mailing address:
  • Phone: 717-272-5464
  • Fax: 717-273-1416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number081003119
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: