Provider Demographics
NPI:1619011624
Name:DALTON, LAWRENCE TIMOTHY (EDD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:TIMOTHY
Last Name:DALTON
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 1:5530 WISCONSIN AVE
Mailing Address - Street 2:SUITE 915
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4404
Mailing Address - Country:US
Mailing Address - Phone:301-951-3668
Mailing Address - Fax:301-654-0376
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 915
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-951-3668
Practice Address - Fax:301-654-0376
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01983103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5469OtherCAREFIRST
MD616731Medicare ID - Type Unspecified