Provider Demographics
NPI:1689227027
Name:LOPEZ, AILI ANAIS (LMHC, ATR)
Entity Type:Individual
Prefix:
First Name:AILI
Middle Name:ANAIS
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LMHC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 WING RD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:12833-1664
Mailing Address - Country:US
Mailing Address - Phone:518-888-4046
Mailing Address - Fax:
Practice Address - Street 1:110 WING RD
Practice Address - Street 2:
Practice Address - City:GREENFIELD CENTER
Practice Address - State:NY
Practice Address - Zip Code:12833
Practice Address - Country:US
Practice Address - Phone:518-888-4046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007442101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health