Provider Demographics
NPI:1295031771
Name:LOPEZ, OTHONIEL (MSW)
Entity Type:Individual
Prefix:
First Name:OTHONIEL
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 W 15TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6701
Mailing Address - Country:US
Mailing Address - Phone:718-963-4430
Mailing Address - Fax:718-963-0814
Practice Address - Street 1:217 HAVEMEYER ST
Practice Address - Street 2:4TH FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-6277
Practice Address - Country:US
Practice Address - Phone:718-963-4430
Practice Address - Fax:718-963-0814
Is Sole Proprietor?:No
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker