Provider Demographics
NPI:1063606770
Name:LOPEZ, CAROL EMILY (PSY D)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:EMILY
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FLORAL PARK
Mailing Address - Street 2:RUIZ BELVIS 10
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917
Mailing Address - Country:US
Mailing Address - Phone:787-763-4548
Mailing Address - Fax:787-545-5337
Practice Address - Street 1:FLORAL PARK
Practice Address - Street 2:RUIZ BELVIS 10
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-763-4548
Practice Address - Fax:787-545-4337
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2120103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical