=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952276081
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICAELA ROPER LISW-CP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2025
-----------------------------------------------------
Last Update Date | 10/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 298 MEMORIAL DR
-----------------------------------------------------
City | SENECA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29672-9443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-404-7487
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 213 SHENANDOAH RD
-----------------------------------------------------
City | TOWNVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29689-2631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-276-3931
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 18100
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------