Provider Demographics
NPI:1750008769
Name:LOPEZ, NELSON A (DSW, LCSW, PSYD)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:A
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:DSW, LCSW, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BO. BRISAS DE TORTUGUERO
Mailing Address - Street 2:BUZON 117 CALLE RIO TURABO
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-312-1846
Mailing Address - Fax:
Practice Address - Street 1:2 CALLE TULIO OTERO
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-4376
Practice Address - Country:US
Practice Address - Phone:787-312-1846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR117811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11781OtherLICENSE CLINICAL SOCIAL WORKER