Provider Demographics
NPI:1396416061
Name:LOPEZ BISONO, SHALIM (SOCIAL WORKER)
Entity Type:Individual
Prefix:MRS
First Name:SHALIM
Middle Name:
Last Name:LOPEZ BISONO
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 GODWIN TER APT 2C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-5453
Mailing Address - Country:US
Mailing Address - Phone:718-902-6560
Mailing Address - Fax:
Practice Address - Street 1:1265 FRANKLIN AVE FL 4
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3501
Practice Address - Country:US
Practice Address - Phone:718-579-7389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102205104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker