Provider Demographics
NPI:1902831852
Name:LOPEZ, JENNIFER MARIA (DCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MARIA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5926
Mailing Address - Country:US
Mailing Address - Phone:516-795-1915
Mailing Address - Fax:631-691-1254
Practice Address - Street 1:151 BROADWAY
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2729
Practice Address - Country:US
Practice Address - Phone:516-795-1915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR024888-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical