Provider Demographics
NPI:1306095005
Name:LOPEZ, RADAMES MUNIZ (LCSW-R)
Entity type:Individual
Prefix:
First Name:RADAMES
Middle Name:MUNIZ
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 COLUMBIA TPKE
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-2266
Mailing Address - Country:US
Mailing Address - Phone:518-477-7535
Mailing Address - Fax:518-477-7555
Practice Address - Street 1:743 COLUMBIA TPKE
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-2266
Practice Address - Country:US
Practice Address - Phone:518-477-7535
Practice Address - Fax:518-477-7555
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0320151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical