Provider Demographics
NPI:1639298433
Name:LAWRENCE, BETSY ELLEN (PH D)
Entity Type:Individual
Prefix:DR
First Name:BETSY
Middle Name:ELLEN
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7629 CABIN RD
Mailing Address - Street 2:
Mailing Address - City:CABIN JOHN
Mailing Address - State:MD
Mailing Address - Zip Code:20818-1406
Mailing Address - Country:US
Mailing Address - Phone:301-229-6706
Mailing Address - Fax:301-229-9168
Practice Address - Street 1:7629 CABIN RD
Practice Address - Street 2:
Practice Address - City:CABIN JOHN
Practice Address - State:MD
Practice Address - Zip Code:20818-1406
Practice Address - Country:US
Practice Address - Phone:301-229-6706
Practice Address - Fax:301-229-9168
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDC791103G00000X
MD01015103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDGK65BOtherCAREFIRST BLUE CROSS BLUE
MDL76925Medicare ID - Type Unspecified
DC176925Medicare ID - Type Unspecified
MDGK65BOtherCAREFIRST BLUE CROSS BLUE
DCR97359Medicare UPIN