Provider Demographics
NPI:1346284395
Name:LOPEZ, DAISY (LCSW)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6248 80TH RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-6828
Mailing Address - Country:US
Mailing Address - Phone:718-875-6900
Mailing Address - Fax:718-875-3282
Practice Address - Street 1:18 MIDDLETON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5415
Practice Address - Country:US
Practice Address - Phone:718-875-6900
Practice Address - Fax:718-875-3282
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074802-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00074802Medicaid
NYPE0W148710Medicare ID - Type Unspecified