Provider Demographics
NPI:1073540498
Name:LOPEZ, CARMEN P (LMSW-CT)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:P
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LMSW-CT
Other - Prefix:MS
Other - First Name:CARMEN
Other - Middle Name:P
Other - Last Name:LOPEZ
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:LMSW-CT
Mailing Address - Street 1:1050 E 230TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4810
Mailing Address - Country:US
Mailing Address - Phone:718-564-5875
Mailing Address - Fax:718-881-0729
Practice Address - Street 1:1050 E 230TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-4810
Practice Address - Country:US
Practice Address - Phone:718-564-5875
Practice Address - Fax:718-881-0729
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP78800Medicaid