MEDICARE: DR. CHARLES MICHAEL LEPKOWSKY 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	103TC0700X	Clinical Psychologist	PSY 9118	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CP9118	OTHER		MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C107937	OTHER	CA	TRICARE
2	0004226734	OTHER	CA	AETNA

General Provider Information

NPI Number	:	1083617252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES MICHAEL LEPKOWSKY PH.D.

Provider Business Mailing Address
First Line	:	1143 DEER TRAIL LN
Second Line	:
City	:	SOLVANG
State	:	CA
Zip	:	93463-9519
Country	:	US
Telephone Number	:	805-688-1229
Fax Number	:	805-686-9382

Provider Business Practice Location Address
First Line	:	1143 DEER TRAIL LN
Second Line	:
City	:	SOLVANG
State	:	CA
Zip	:	93463-9519
Country	:	US
Telephone Number	:	805-688-1229
Fax Number	:	805-686-9382

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	03/07/2011

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