Provider Demographics
NPI:1689806085
Name:LOPEZ, JOAN M
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:M
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYCHOLOGIST
Mailing Address - Street 1:PARQUE DE ARCOIRIS NUM.227
Mailing Address - Street 2:2ND. ST. APT.119
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-2853
Mailing Address - Country:US
Mailing Address - Phone:787-627-1773
Mailing Address - Fax:
Practice Address - Street 1:416 PONCE DE LEON AVE.
Practice Address - Street 2:UNION PLAZA BLDG. SUITE 1511
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3423
Practice Address - Country:US
Practice Address - Phone:787-630-7283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1960103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling