MEDICARE: MS. SALLY LOPER 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	15561-1	NY

General Provider Information

NPI Number	:	1457415812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SALLY LOPER LCSW

Provider Business Mailing Address
First Line	:	200 W 70TH ST
Second Line	:	#12B
City	:	NEW YORK
State	:	NY
Zip	:	10023-4323
Country	:	US
Telephone Number	:	212-724-5679
Fax Number	:	212-724-0875

Provider Business Practice Location Address
First Line	:	200 W 70TH ST
Second Line	:	#12B
City	:	NEW YORK
State	:	NY
Zip	:	10023-4323
Country	:	US
Telephone Number	:	212-724-5679
Fax Number	:	212-724-0875

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/09/2007

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