Provider Demographics
NPI:1205563285
Name:NOLASCO-LOPEZ, MCQUERNA (MBA, MHS)
Entity type:Individual
Prefix:
First Name:MCQUERNA
Middle Name:
Last Name:NOLASCO-LOPEZ
Suffix:
Gender:F
Credentials:MBA, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13243
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-3243
Mailing Address - Country:US
Mailing Address - Phone:484-509-1038
Mailing Address - Fax:610-424-7578
Practice Address - Street 1:4641 POTTSVILLE PIKE STE 101B
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-9707
Practice Address - Country:US
Practice Address - Phone:484-509-1038
Practice Address - Fax:610-424-7578
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty