Provider Demographics
NPI:1467622795
Name:LOPEZ, REBECCA M (PSYCHOLOGIST)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:M
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYCHOLOGIST
Mailing Address - Street 1:1300 CALLE 7 # 1300
Mailing Address - Street 2:BOX 119
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-4579
Mailing Address - Country:US
Mailing Address - Phone:787-246-6524
Mailing Address - Fax:787-703-4115
Practice Address - Street 1:M31 CALLE 13
Practice Address - Street 2:CONDADO MODERNO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2443
Practice Address - Country:US
Practice Address - Phone:787-703-4050
Practice Address - Fax:787-703-4115
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2996103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent