MEDICARE: MR. PHILIP LOYDPIERSON M.S.W.

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	1041C0700X	Clinical Social Worker	C001636	NC
2	106H00000X	Marriage & Family Therapist	437	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	53118	OTHER	NC	BLUE CROSS/BLUE SHEILD

General Provider Information

NPI Number	:	1275702029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHILIP LOYDPIERSON M.S.W.

Provider Business Mailing Address
First Line	:	3214 STONEYBROOK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-3154
Country	:	US
Telephone Number	:	704-342-3456
Fax Number	:

Provider Business Practice Location Address
First Line	:	3214 STONEYBROOK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-3154
Country	:	US
Telephone Number	:	704-342-3456
Fax Number	:

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

Provider Enumeration Date	:	02/26/2008
Last Update Date	:	02/26/2008

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