Provider Demographics
NPI:1710657432
Name:LOPEZ-TOBIA, LORENA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LORENA
Middle Name:
Last Name:LOPEZ-TOBIA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 W 13TH ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7803
Mailing Address - Country:US
Mailing Address - Phone:201-394-2520
Mailing Address - Fax:
Practice Address - Street 1:175 W 13TH ST APT 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7803
Practice Address - Country:US
Practice Address - Phone:201-394-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
NY110044-01390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist