Provider Demographics
NPI:1457415812
Name:LOPER, SALLY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:
Last Name:LOPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 70TH ST
Mailing Address - Street 2:#12B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4323
Mailing Address - Country:US
Mailing Address - Phone:212-724-5679
Mailing Address - Fax:212-724-0875
Practice Address - Street 1:200 W 70TH ST
Practice Address - Street 2:#12B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4323
Practice Address - Country:US
Practice Address - Phone:212-724-5679
Practice Address - Fax:212-724-0875
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15561-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN02372Medicare PIN