Provider Demographics
NPI:1467798447
Name:LINEHAN LOPEZ, SIOBHAN (LCMHC)
Entity Type:Individual
Prefix:MS
First Name:SIOBHAN
Middle Name:
Last Name:LINEHAN LOPEZ
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:STRAFFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05072-0102
Mailing Address - Country:US
Mailing Address - Phone:802-765-4387
Mailing Address - Fax:
Practice Address - Street 1:3 ATWOOD AVE
Practice Address - Street 2:
Practice Address - City:WEST LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03784-1401
Practice Address - Country:US
Practice Address - Phone:802-765-4387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH963101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health