MEDICARE: JOHANNA GROEPL L.M.F.T.

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	106H00000X	Marriage & Family Therapist	000288	NY

General Provider Information

NPI Number	:	1972794709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHANNA GROEPL L.M.F.T.

Provider Business Mailing Address
First Line	:	58 CONCORD RD
Second Line	:
City	:	CARMEL
State	:	NY
Zip	:	10512-6826
Country	:	US
Telephone Number	:	845-306-1843
Fax Number	:

Provider Business Practice Location Address
First Line	:	963 ROUTE 22
Second Line	:
City	:	BREWSTER
State	:	NY
Zip	:	10509-1526
Country	:	US
Telephone Number	:	845-306-1843
Fax Number	:

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

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

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