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General NPI Number Information
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NPI Number | 1114139557
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Entity Type | Individual
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Provider Name | LAWRENCE J. RAIFMAN PH.D., J. D.
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Gender | Male
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Dates
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Enumeration Date | 05/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1501 SULGRAVE AVE SUITE 208
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City | BALTIMORE
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State | MD
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Zip | 21209-3654
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Country | US
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Telephone | 410-998-9245
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Fax | 410-998-9250
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Provider Business Mailing Address
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Address Line | 11005 VALLEY HEIGHTS DR
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City | OWINGS MILLS
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State | MD
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Zip | 21117-3056
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Country | US
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Telephone | 410-998-9245
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Fax | 410-998-9250
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1757
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License Number State | MD
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