Provider Demographics
NPI:1801297668
Name:STEPHANIE LOPEZ, LLC
Entity type:Organization
Organization Name:STEPHANIE LOPEZ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:614-725-2772
Mailing Address - Street 1:3040 RIVERSIDE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2551
Mailing Address - Country:US
Mailing Address - Phone:614-725-2772
Mailing Address - Fax:
Practice Address - Street 1:3040 RIVERSIDE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2551
Practice Address - Country:US
Practice Address - Phone:614-725-2772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty