Provider Demographics
NPI:1205800620
Name:LEFEVER, BRYCE EDWIN (PHD ABPP)
Entity type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:EDWIN
Last Name:LEFEVER
Suffix:
Gender:M
Credentials:PHD ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-8095
Mailing Address - Country:US
Mailing Address - Phone:717-272-5464
Mailing Address - Fax:717-273-1416
Practice Address - Street 1:5400 BIG TYLER RD # D
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25313-1178
Practice Address - Country:US
Practice Address - Phone:717-848-6116
Practice Address - Fax:717-852-7580
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA081003119103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical