Provider Demographics
NPI:1235482290
Name:LOPES, LOIDE M
Entity Type:Individual
Prefix:
First Name:LOIDE
Middle Name:M
Last Name:LOPES
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 1:3048 PAWTUCKET AVE
Mailing Address - Street 2:APT.102
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-5051
Mailing Address - Country:US
Mailing Address - Phone:401-663-5487
Mailing Address - Fax:
Practice Address - Street 1:3048 PAWTUCKET AVE
Practice Address - Street 2:APT.102
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-5051
Practice Address - Country:US
Practice Address - Phone:401-663-5487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist