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NPI Code Detail

MEDICARE: LEE ANTHONY UNDERWOOD PSY.D.

MEDICARE:   LEE ANTHONY UNDERWOOD  PSY.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
1103TC0700XClinical Psychologist0810002695VA
2103TC2200XClinical Child & Adolescent Psychologist0810002695VA

General Provider Information

NPI Number : 1972774347
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEE ANTHONY UNDERWOOD PSY.D.
Provider Business Mailing Address
First Line : 2744 NESTLEBROOK TRL
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23456-8221
Country : US
Telephone Number : 757-630-4442
Fax Number :
Provider Business Practice Location Address
First Line : 900 COMMONWEALTH PL
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23464-4517
Country : US
Telephone Number : 757-274-8221
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2008
Last Update Date : 03/13/2008

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Directions to “ LEE ANTHONY UNDERWOOD PSY.D.” Practice Location

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