MEDICARE: DR. GEORGE BARRETT LITCHFORD PH.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	05053	NY

General Provider Information

NPI Number	:	1710029434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE BARRETT LITCHFORD PH.D

Provider Business Mailing Address
First Line	:	67 S LAKE AVE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12203-1103
Country	:	US
Telephone Number	:	518-449-7317
Fax Number	:

Provider Business Practice Location Address
First Line	:	67 S LAKE AVE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12203-1103
Country	:	US
Telephone Number	:	518-449-7317
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	07/08/2007

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