MEDICARE: RONKE LATTIMORE TAPP PH.D.

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	103TC1900X	Counseling Psychologist	017355	NY

General Provider Information

NPI Number	:	1518116243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONKE LATTIMORE TAPP PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 270356
Second Line	:	UNIVERSITY COUNSELING CENTER, U OF ROCHESTER
City	:	ROCHESTER
State	:	NY
Zip	:	14627-0356
Country	:	US
Telephone Number	:	585-275-3113
Fax Number	:	585-442-0815

Provider Business Practice Location Address
First Line	:	738 LIBRARY ROAD
Second Line	:	3RD FLR UNIVERSITY COUNSELING CENTER U OF ROCHESTER
City	:	ROCHESTER
State	:	NY
Zip	:	14627-0356
Country	:	US
Telephone Number	:	585-275-3113
Fax Number	:	585-442-0815

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

Provider Enumeration Date	:	09/18/2008
Last Update Date	:	09/18/2008

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