Provider Demographics
NPI:1154441699
Name:LEBEDUN, ALEC (PHD)
Entity Type:Individual
Prefix:
First Name:ALEC
Middle Name:
Last Name:LEBEDUN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CAMERON ST STE 307
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2506
Mailing Address - Country:US
Mailing Address - Phone:703-283-3325
Mailing Address - Fax:571-418-0078
Practice Address - Street 1:600 CAMERON ST STE 307
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2506
Practice Address - Country:US
Practice Address - Phone:703-283-3325
Practice Address - Fax:571-418-0078
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001828103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB570-0001OtherCARE FIRST BLUE CROSS
DCG01652N01Medicare PIN
R23095Medicare UPIN