MEDICARE: MR. JOSEPH ANTHONY LOPES 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	CW012098	PA

General Provider Information

NPI Number	:	1891053377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH ANTHONY LOPES LCSW

Provider Business Mailing Address
First Line	:	629 E DRINKER ST STE 2
Second Line	:	DUNMORE PROFESSIONAL BUILDING
City	:	DUNMORE
State	:	PA
Zip	:	18512-2549
Country	:	US
Telephone Number	:	610-212-1744
Fax Number	:	570-888-1459

Provider Business Practice Location Address
First Line	:	629 E. DRINKER STREET SECOND FLOOR
Second Line	:	DUNMORE PROFESSIONAL PLAZA
City	:	DUNMORE
State	:	PA
Zip	:	18512-1255
Country	:	US
Telephone Number	:	610-212-1744
Fax Number	:	570-800-1459

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

Provider Enumeration Date	:	05/02/2012
Last Update Date	:	03/23/2016

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