Provider Demographics
NPI:1437440781
Name:LOPEZ, ISAAC (LCSW)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 LAKE ST STE 614
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1136
Mailing Address - Country:US
Mailing Address - Phone:708-657-7527
Mailing Address - Fax:708-405-2044
Practice Address - Street 1:1010 LAKE ST STE 614
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1136
Practice Address - Country:US
Practice Address - Phone:708-657-7527
Practice Address - Fax:708-405-2044
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0134751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical