MEDICARE: DR. LENORA M POE PHD

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	103T00000X	Psychologist	MFT20628	CA

General Provider Information

NPI Number	:	1013077247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LENORA M POE PHD

Provider Business Mailing Address
First Line	:	2034 BLAKE ST
Second Line	:	#1
City	:	BERKELEY
State	:	CA
Zip	:	94704
Country	:	US
Telephone Number	:	510-845-7189
Fax Number	:	510-845-2330

Provider Business Practice Location Address
First Line	:	2034 BLAKE ST
Second Line	:	#1
City	:	BERKELEY
State	:	CA
Zip	:	94704
Country	:	US
Telephone Number	:	510-845-7189
Fax Number	:	510-845-2330

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/08/2007

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