MEDICARE: DR. MARIE LOUISE LEPAGE PH.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	1272	SC

General Provider Information

NPI Number	:	1598107302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIE LOUISE LEPAGE PH.D.

Provider Business Mailing Address
First Line	:	153 N SPRING ST
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29306-2309
Country	:	US
Telephone Number	:	443-956-0541
Fax Number	:

Provider Business Practice Location Address
First Line	:	153 N SPRING ST
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29306-2309
Country	:	US
Telephone Number	:	443-956-0541
Fax Number	:

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

Provider Enumeration Date	:	07/22/2013
Last Update Date	:	07/22/2013

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