Provider Demographics
NPI:1043559420
Name:LOPEZ, CARLOS A (MSW, LCADC)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:A
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19-21 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-4107
Mailing Address - Country:US
Mailing Address - Phone:973-361-5555
Mailing Address - Fax:973-361-7354
Practice Address - Street 1:19-21 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-4107
Practice Address - Country:US
Practice Address - Phone:973-361-5555
Practice Address - Fax:973-361-7354
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00097800101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)