Provider Demographics
NPI:1063696466
Name:CHASE PSYCHOLOGICAL RESOURCES, INC.
Entity type:Organization
Organization Name:CHASE PSYCHOLOGICAL RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-325-5043
Mailing Address - Street 1:327 CHESTERTOWN ST
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5686
Mailing Address - Country:US
Mailing Address - Phone:301-325-5043
Mailing Address - Fax:
Practice Address - Street 1:10721 MAIN ST
Practice Address - Street 2:SUITE 2350
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6914
Practice Address - Country:US
Practice Address - Phone:703-591-5912
Practice Address - Fax:703-591-7210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03341103G00000X
VA0810002159103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1588702047OtherNPI
MD1861493520OtherNPI