MEDICARE: ROBYN KELLEY LOVELL 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	104100000X	Social Worker	27784	TX
2	1041C0700X	Clinical Social Worker	6288	TN

General Provider Information

NPI Number	:	1417382151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBYN KELLEY LOVELL LCSW

Provider Business Mailing Address
First Line	:	531 COLLIERS BEND RD
Second Line	:
City	:	CHARLOTTE
State	:	TN
Zip	:	37036-5700
Country	:	US
Telephone Number	:	615-516-3420
Fax Number	:

Provider Business Practice Location Address
First Line	:	531 COLLIERS BEND RD
Second Line	:
City	:	CHARLOTTE
State	:	TN
Zip	:	37036-5700
Country	:	US
Telephone Number	:	615-516-3420
Fax Number	:

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

Provider Enumeration Date	:	09/12/2013
Last Update Date	:	08/09/2019

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