MEDICARE: LESTER LOWERY M.ED.

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1679952519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESTER LOWERY M.ED.

Provider Business Mailing Address
First Line	:	5706 DUNLAP ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-3412
Country	:	US
Telephone Number	:	215-847-2507
Fax Number	:

Provider Business Practice Location Address
First Line	:	5706 DUNLAP ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-3412
Country	:	US
Telephone Number	:	215-847-2507
Fax Number	:

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

Provider Enumeration Date	:	05/26/2015
Last Update Date	:	05/26/2015

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