MEDICARE: LEE DANIEL CRUMP 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	103T00000X	Psychologist	01728	MD

General Provider Information

NPI Number	:	1780813790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE DANIEL CRUMP PH.D.

Provider Business Mailing Address
First Line	:	7913 BELLE POINT DR
Second Line	:
City	:	GREENBELT
State	:	MD
Zip	:	20770-3329
Country	:	US
Telephone Number	:	301-220-0982
Fax Number	:	301-220-0984

Provider Business Practice Location Address
First Line	:	7913 BELLE POINT DR
Second Line	:
City	:	GREENBELT
State	:	MD
Zip	:	20770-3329
Country	:	US
Telephone Number	:	301-220-0982
Fax Number	:	301-220-0984

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

Provider Enumeration Date	:	07/11/2009
Last Update Date	:	07/11/2009

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