Provider Demographics
NPI:1225306640
Name:LOPEZ, LUZ MERCEDES (MS)
Entity Type:Individual
Prefix:MS
First Name:LUZ
Middle Name:MERCEDES
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1844 WHITNEY AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-1400
Mailing Address - Country:US
Mailing Address - Phone:203-407-1310
Mailing Address - Fax:203-407-1309
Practice Address - Street 1:1844 WHITNEY AVE STE 2
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-1400
Practice Address - Country:US
Practice Address - Phone:203-407-1310
Practice Address - Fax:203-407-1309
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5447101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional