MEDICARE: DR. ROBIN CAROL POPE SANTA TERESA PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1131	NM
2	103TH0004X	Health Psychologist	008595	CO
3	103TS0200X	School Psychologist	0352018	CO
4	103TS0200X	School Psychologist	220680	NM

General Provider Information

NPI Number	:	1225294234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBIN CAROL POPE SANTA TERESA PSYD

Provider Business Mailing Address
First Line	:	3934 NORTH DIXIE HIGHWAY SUITE 210
Second Line	:	VA HEALTHCARE SHIVELY
City	:	LOUISVILLE
State	:	KY
Zip	:	40216
Country	:	US
Telephone Number	:	502-827-6207
Fax Number	:	502-449-1931

Provider Business Practice Location Address
First Line	:	3934 NORTH DIXIE HIGHWAY
Second Line	:	SUITE 210
City	:	LOUISVILLE
State	:	KY
Zip	:	40216
Country	:	US
Telephone Number	:	502-827-6207
Fax Number	:	502-449-1931

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2008
Last Update Date	:	04/05/2012

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Directions to “ DR. ROBIN CAROL POPE SANTA TERESA PSYD” Practice Location

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