Provider Demographics
NPI:1083211189
Name:LOPEZ, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SEDGWICK AVE APT 20F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-6603
Mailing Address - Country:US
Mailing Address - Phone:631-353-1520
Mailing Address - Fax:
Practice Address - Street 1:1600 SEDGWICK AVE APT 20F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-6603
Practice Address - Country:US
Practice Address - Phone:631-353-1520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker