Provider Demographics
NPI:1679239594
Name:LOPEZ, ASHLEY VIRGINIA (LSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:VIRGINIA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 AYCRIGG AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-5609
Mailing Address - Country:US
Mailing Address - Phone:862-900-9146
Mailing Address - Fax:
Practice Address - Street 1:28 AYCRIGG AVE APT 2
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5609
Practice Address - Country:US
Practice Address - Phone:862-900-9146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06261400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker