MEDICARE: MR. ROBERT LOUZAN LMHC

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	LM0234	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LM0234	OTHER	MA	INSURANCE PROVIDER NUMBER

General Provider Information

NPI Number	:	1710906151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT LOUZAN LMHC

Provider Business Mailing Address
First Line	:	226 LAKE SHORE DR
Second Line	:
City	:	E FALMOUTH
State	:	MA
Zip	:	02536-4711
Country	:	US
Telephone Number	:	508-274-2587
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 COLUMBIA RD
Second Line	:	SUITE #8
City	:	PEMBROKE
State	:	MA
Zip	:	02359-1842
Country	:	US
Telephone Number	:	781-826-7940
Fax Number	:	781-826-7940

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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