MEDICARE: DR. LOUISE RAPHAELA LOPEZ PSY.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	PY7869	FL

General Provider Information

NPI Number	:	1174761787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUISE RAPHAELA LOPEZ PSY.D.

Provider Business Mailing Address
First Line	:	1760 NE 13TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-1846
Country	:	US
Telephone Number	:	561-351-6232
Fax Number	:

Provider Business Practice Location Address
First Line	:	1760 NE 13TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-1846
Country	:	US
Telephone Number	:	561-351-6232
Fax Number	:

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

Provider Enumeration Date	:	02/04/2009
Last Update Date	:	03/10/2011

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