Provider Demographics
NPI:1578997821
Name:LOPEZ, MARIA (03/09/06)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:03/09/06
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 EASTCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2604
Mailing Address - Country:US
Mailing Address - Phone:718-405-8040
Mailing Address - Fax:718-405-8065
Practice Address - Street 1:1621 EASTCHESTER RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2604
Practice Address - Country:US
Practice Address - Phone:718-405-8040
Practice Address - Fax:718-405-8065
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072442104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker