Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | PSY1000023 | DC |
NPI | 1013001304 |
---|---|
Provider Name | Lise Becker Vezina |
First Address | Washington, DC 20008-3425 |
Second Address | Silver Spring, MD 20910-4324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |