Provider Demographics
NPI:1932447927
Name:LOPEZ, LUIS (LMHC, CASAC)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LMHC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10702-0010
Mailing Address - Country:US
Mailing Address - Phone:917-545-2674
Mailing Address - Fax:
Practice Address - Street 1:611 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-3106
Practice Address - Country:US
Practice Address - Phone:917-545-2674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-25
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005526101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005526-1OtherLMHC
NY21885OtherCASAC