Provider Demographics
NPI:1457044729
Name:LOPEZ, LIZETH PAOLA
Entity Type:Individual
Prefix:
First Name:LIZETH
Middle Name:PAOLA
Last Name: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 1:324 WASHINGTON AVE APT C3
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-3360
Mailing Address - Country:US
Mailing Address - Phone:929-365-0826
Mailing Address - Fax:
Practice Address - Street 1:324 WASHINGTON AVE APT C3
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3360
Practice Address - Country:US
Practice Address - Phone:929-365-0826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRBT-21-196223103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst