Provider Demographics
NPI:1801262209
Name:LOPEZ, EDWIN (MA, MHC)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MA, MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 JOHNSON AVE APT 1G
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1668
Mailing Address - Country:US
Mailing Address - Phone:646-734-5798
Mailing Address - Fax:
Practice Address - Street 1:3601 JOHNSON AVE APT 1G
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1668
Practice Address - Country:US
Practice Address - Phone:646-734-5798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health