MEDICARE: MRS. LORENE MARIE ROPER LCSW

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	1041C0700X	Clinical Social Worker	7096	OK
2	1041C0700X	Clinical Social Worker	09928303	CO

General Provider Information

NPI Number	:	1154850238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORENE MARIE ROPER LCSW

Provider Business Mailing Address
First Line	:	1586 S 21ST ST STE 20
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-4260
Country	:	US
Telephone Number	:	405-213-9043
Fax Number	:	405-251-8538

Provider Business Practice Location Address
First Line	:	1586 S 21ST ST STE 20
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-4260
Country	:	US
Telephone Number	:	405-213-9043
Fax Number	:	405-251-8538

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

Provider Enumeration Date	:	06/12/2017
Last Update Date	:	01/27/2024

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