Provider Demographics
NPI:1588044879
Name:LOPEZ DE VALDIVIA, MARIE-PAULE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIE-PAULE
Middle Name:
Last Name:LOPEZ DE VALDIVIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARIE-PAULE
Other - Middle Name:
Other - Last Name:DE VALDIVIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:90 FIFTH AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-7778
Mailing Address - Country:US
Mailing Address - Phone:203-981-0113
Mailing Address - Fax:
Practice Address - Street 1:90 FIFTH AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-7778
Practice Address - Country:US
Practice Address - Phone:203-981-0113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0088841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical