MEDICARE: MICHELLE ROPER

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1609245547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE ROPER

Provider Business Mailing Address
First Line	:	4811 MURDOCK AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10470-1209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4811 MURDOCK AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10470-1209
Country	:	US
Telephone Number	:	718-473-7290
Fax Number	:

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

Provider Enumeration Date	:	09/22/2015
Last Update Date	:	09/22/2015

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Directions to “ MICHELLE ROPER ” Practice Location

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