Provider Demographics
NPI:1629208574
Name:LOPEZ, ESTELA MARIA (PSY,D)
Entity Type:Individual
Prefix:MISS
First Name:ESTELA
Middle Name:MARIA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PSY,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 CALLE FERMIN ZEDO
Mailing Address - Street 2:URB FAIR VIEW CUPEY
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7627
Mailing Address - Country:US
Mailing Address - Phone:787-403-5594
Mailing Address - Fax:
Practice Address - Street 1:12 AVE ALEJANDRINO
Practice Address - Street 2:URB VILLA CLEMENTINA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4712
Practice Address - Country:US
Practice Address - Phone:787-689-0519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1910103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical