Provider Demographics
NPI:1700641370
Name:LOPEZ ROMERO, LUCELIS (BEHAVIORAL HEALTH)
Entity Type:Individual
Prefix:MISS
First Name:LUCELIS
Middle Name:
Last Name:LOPEZ ROMERO
Suffix:
Gender:F
Credentials:BEHAVIORAL HEALTH
Other - Prefix:MISS
Other - First Name:LUCELIS
Other - Middle Name:
Other - Last Name:LOPEZ ROMERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BEHAVIORAL HEALTH
Mailing Address - Street 1:155 WASHINGTON ST APT 410
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4576
Mailing Address - Country:US
Mailing Address - Phone:551-260-3654
Mailing Address - Fax:551-260-3654
Practice Address - Street 1:395 ROUTE 70 STE 202
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-6161
Practice Address - Country:US
Practice Address - Phone:732-719-1256
Practice Address - Fax:732-544-0364
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJIOE0919203886106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician