Provider Demographics
NPI:1013001304
Name:BECKER VEZINA, LISE (PHD)
Entity Type:Individual
Prefix:
First Name:LISE
Middle Name:
Last Name:BECKER VEZINA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 CORTLAND PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-3425
Mailing Address - Country:US
Mailing Address - Phone:202-588-9447
Mailing Address - Fax:
Practice Address - Street 1:8607 CEDAR ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4324
Practice Address - Country:US
Practice Address - Phone:301-562-8448
Practice Address - Fax:301-562-8449
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000023103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral