MEDICARE: DR. KERRY A. LOPE 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	103TS0200X	School Psychologist	267447	SC

General Provider Information

NPI Number	:	1306245444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KERRY A. LOPE PSY. D.

Provider Business Mailing Address
First Line	:	3750 DORCHESTER RD
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-7567
Country	:	US
Telephone Number	:	843-745-7113
Fax Number	:	843-529-3906

Provider Business Practice Location Address
First Line	:	3750 DORCHESTER RD
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-7567
Country	:	US
Telephone Number	:	843-745-7113
Fax Number	:	843-529-3906

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

Provider Enumeration Date	:	08/14/2014
Last Update Date	:	08/14/2014

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