Provider Demographics
NPI:1104630193
Name:LOPEZ, LA-ELEYA (LSW)
Entity type:Individual
Prefix:
First Name:LA-ELEYA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 WINDEMERE LN
Mailing Address - Street 2:
Mailing Address - City:LANDISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17538-1560
Mailing Address - Country:US
Mailing Address - Phone:717-315-4371
Mailing Address - Fax:833-946-3162
Practice Address - Street 1:1400 WINDEMERE LN
Practice Address - Street 2:
Practice Address - City:LANDISVILLE
Practice Address - State:PA
Practice Address - Zip Code:17538-1560
Practice Address - Country:US
Practice Address - Phone:717-315-4371
Practice Address - Fax:833-946-3162
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW142216104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker