Provider Demographics
NPI:1437531480
Name:LOPEZ, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 SW 73RD WAY
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1104
Mailing Address - Country:US
Mailing Address - Phone:954-383-7297
Mailing Address - Fax:
Practice Address - Street 1:2629 SW 73RD WAY
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-1104
Practice Address - Country:US
Practice Address - Phone:954-383-7297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health