MEDICARE: HEATHER KATHARINE LOPES MS, LPC

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	101YM0800X	Mental Health Counselor	37PC00365700	NJ

General Provider Information

NPI Number	:	1467635987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER KATHARINE LOPES MS, LPC

Provider Business Mailing Address
First Line	:	15 W PROSPECT ST
Second Line	:	UPPER FLOOR
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-2161
Country	:	US
Telephone Number	:	732-254-0600
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 W PROSPECT ST
Second Line	:	UPPER FLOOR
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-2161
Country	:	US
Telephone Number	:	732-254-0600
Fax Number	:

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

Provider Enumeration Date	:	12/06/2007
Last Update Date	:	12/06/2007

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