Provider Demographics
NPI:1982172748
Name:LOPEZ, SHEENA RAE
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:RAE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHEENA
Other - Middle Name:RAE
Other - Last Name:CRAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SHEENA CRAIN
Mailing Address - Street 1:30735 LAVIGNE LN
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:LA
Mailing Address - Zip Code:70711-3135
Mailing Address - Country:US
Mailing Address - Phone:985-415-4157
Mailing Address - Fax:
Practice Address - Street 1:1250 SW RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5001
Practice Address - Country:US
Practice Address - Phone:985-500-3240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008450607106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician