Provider Demographics
NPI:1851717276
Name:LOPEZ, HAYDEE E
Entity Type:Individual
Prefix:
First Name:HAYDEE
Middle Name:E
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8325 CALLE BELMONTE
Mailing Address - Street 2:VISTAS DEL OCEANO
Mailing Address - City:LOIZA
Mailing Address - State:PR
Mailing Address - Zip Code:00772-9757
Mailing Address - Country:US
Mailing Address - Phone:787-314-7605
Mailing Address - Fax:787-256-9256
Practice Address - Street 1:CARRETERA 187 KILOMETRO 7
Practice Address - Street 2:MEDIANIA ALTA
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772
Practice Address - Country:US
Practice Address - Phone:787-314-7605
Practice Address - Fax:787-876-0519
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005214103T00000X, 103TB0200X, 103TF0000X, 103TM1800X, 103TP2701X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool