Provider Demographics
NPI:1215286216
Name:AIDA LOPEZ
Entity type:Organization
Organization Name:AIDA LOPEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AIDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:I
Authorized Official - Credentials:SW
Authorized Official - Phone:347-556-0991
Mailing Address - Street 1:417 PARK AVE
Mailing Address - Street 2:APT 9SW
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4401
Mailing Address - Country:US
Mailing Address - Phone:347-556-0991
Mailing Address - Fax:
Practice Address - Street 1:417 PARK AVE
Practice Address - Street 2:APT 9SW
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4401
Practice Address - Country:US
Practice Address - Phone:347-556-0991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086269252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency