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General NPI Number Information
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NPI Number | 1972774347
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Entity Type | Individual
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Provider Name | LEE ANTHONY UNDERWOOD PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 03/13/2008
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Provider Practice Location Address
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Address Line | 900 COMMONWEALTH PL
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4517
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Country | US
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Telephone | 757-274-8221
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Fax |
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Provider Business Mailing Address
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Address Line | 2744 NESTLEBROOK TRL
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-8221
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Country | US
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Telephone | 757-630-4442
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810002695
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 0810002695
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License Number State | VA
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