MEDICARE: DR. MARY HACOPIAN 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	103T00000X	Psychologist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0000WDBCH	OTHER	OR	GROUP MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295878239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY HACOPIAN PSY.D.

Provider Business Mailing Address
First Line	:	14588 SW SHOUE DR
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97224
Country	:	US
Telephone Number	:	818-438-6671
Fax Number	:	866-803-2248

Provider Business Practice Location Address
First Line	:	10700 SW BEAVERTON HILLSDALE HWY STE 450
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97005-4736
Country	:	US
Telephone Number	:	503-928-6624
Fax Number	:	866-803-2248

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	09/28/2016

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