Provider Demographics
NPI:1265893101
Name:GONZALEZ-LOPEZ, ADRIANA (EDD, BCBA-D, LBS)
Entity type:Individual
Prefix:DR
First Name:ADRIANA
Middle Name:
Last Name:GONZALEZ-LOPEZ
Suffix:
Gender:F
Credentials:EDD, BCBA-D, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 EATON DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3856
Mailing Address - Country:US
Mailing Address - Phone:610-937-0885
Mailing Address - Fax:
Practice Address - Street 1:103 EATON DR
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3856
Practice Address - Country:US
Practice Address - Phone:610-937-0885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002817103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst