Provider Demographics
NPI:1245880418
Name:LOPEZ-ESPELIN, ESTELA (LCSW, MA)
Entity type:Individual
Prefix:
First Name:ESTELA
Middle Name:
Last Name:LOPEZ-ESPELIN
Suffix:
Gender:F
Credentials:LCSW, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 BOSTON POST RD UNIT 321
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-7706
Mailing Address - Country:US
Mailing Address - Phone:203-244-8363
Mailing Address - Fax:
Practice Address - Street 1:145 DURHAM RD STE 6
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2656
Practice Address - Country:US
Practice Address - Phone:203-244-8363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2022-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT107171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical