Provider Demographics
NPI:1205601192
Name:LUNA LOPEZ, PAULA ANDREA
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:ANDREA
Last Name:LUNA 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 1:8230 LITTLE NECK PKWY
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1424
Mailing Address - Country:US
Mailing Address - Phone:646-714-5342
Mailing Address - Fax:
Practice Address - Street 1:8230 LITTLE NECK PKWY
Practice Address - Street 2:
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1424
Practice Address - Country:US
Practice Address - Phone:646-714-5342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst