Provider Demographics
NPI:1477941227
Name:LOPEZ, LIZA FERNANDA
Entity Type:Individual
Prefix:MRS
First Name:LIZA FERNANDA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 MERRIMACK ST
Mailing Address - Street 2:APT 300
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1772
Mailing Address - Country:US
Mailing Address - Phone:617-777-0388
Mailing Address - Fax:
Practice Address - Street 1:210 MERRIMACK ST
Practice Address - Street 2:APT 300
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1772
Practice Address - Country:US
Practice Address - Phone:617-777-0388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health