MEDICARE: MICHELE KOEPPEL 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	SW8208	FL

General Provider Information

NPI Number	:	1821103979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE KOEPPEL LCSW

Provider Business Mailing Address
First Line	:	15300 JOG RD
Second Line	:	SUITE 109
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-2162
Country	:	US
Telephone Number	:	561-499-2700
Fax Number	:	561-499-2775

Provider Business Practice Location Address
First Line	:	15300 JOG RD
Second Line	:	SUITE 109
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-2162
Country	:	US
Telephone Number	:	561-499-2700
Fax Number	:	561-499-2775

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/08/2007

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