Provider Demographics
NPI:1043699606
Name:LOPEZ, ESTEVEN
Entity Type:Individual
Prefix:
First Name:ESTEVEN
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 SAINT NICHOLAS AVE APT 36
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-7207
Mailing Address - Country:US
Mailing Address - Phone:917-361-1364
Mailing Address - Fax:
Practice Address - Street 1:1306 SAINT NICHOLAS AVE APT 36
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-7207
Practice Address - Country:US
Practice Address - Phone:917-361-1364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst