Provider Demographics
NPI:1902882335
Name:OWENS, LEE F (EDD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:F
Last Name:OWENS
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 BALSAM TREE CT
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2852
Mailing Address - Country:US
Mailing Address - Phone:410-224-2021
Mailing Address - Fax:410-224-2420
Practice Address - Street 1:127 LUBRANO DR
Practice Address - Street 2:SUITE L-3
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7078
Practice Address - Country:US
Practice Address - Phone:410-224-2021
Practice Address - Fax:410-224-2420
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-18
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02540103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD397SMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #