Provider Demographics
NPI:1215214838
Name:LOPEZ, RACHAEL (LSW)
Entity Type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:STIRLING
Mailing Address - State:NJ
Mailing Address - Zip Code:07980-1523
Mailing Address - Country:US
Mailing Address - Phone:908-604-4500
Mailing Address - Fax:908-604-4505
Practice Address - Street 1:1071 VALLEY RD
Practice Address - Street 2:
Practice Address - City:STIRLING
Practice Address - State:NJ
Practice Address - Zip Code:07980-1523
Practice Address - Country:US
Practice Address - Phone:908-604-4500
Practice Address - Fax:908-604-4505
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NJ44SL05558500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst