Provider Demographics
NPI:1710040464
Name:LYTLE, LINDA RISSER (PHD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:RISSER
Last Name:LYTLE
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 1:4300 TUCKERMAN ST
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2145
Mailing Address - Country:US
Mailing Address - Phone:301-779-0456
Mailing Address - Fax:301-779-0456
Practice Address - Street 1:1609 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 300
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-1034
Practice Address - Country:US
Practice Address - Phone:301-779-0456
Practice Address - Fax:301-779-0456
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1533103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical