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General NPI Number Information
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NPI Number | 1104375963
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Entity Type | Individual
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Provider Name | BYRON MCCLURE S.S.P, NCSP
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Gender | Male
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 3231 SUPERIOR LN SUITE A6
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City | BOWIE
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State | MD
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Zip | 20715-1923
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Country | US
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Telephone | 301-464-5129
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Fax |
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Provider Business Mailing Address
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Address Line | 2641 LACROSSE PL
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City | WALDORF
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State | MD
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Zip | 20603-3871
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Country | US
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Telephone | 301-442-2447
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 08-6200
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License Number State | MD
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