Provider Demographics
NPI:1871745844
Name:LEVINE, LAURENCE RAYMOND (PSYD)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:RAYMOND
Last Name:LEVINE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9121 ORCHARD BROOK DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2404
Mailing Address - Country:US
Mailing Address - Phone:240-393-3986
Mailing Address - Fax:301-610-0464
Practice Address - Street 1:9121 ORCHARD BROOK DR
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-2404
Practice Address - Country:US
Practice Address - Phone:240-393-3986
Practice Address - Fax:301-610-0464
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical