Provider Demographics
NPI:1326177197
Name:LOPEZ, MARIANA C (LMSW)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:C
Last Name:LOPEZ
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 ARKANSAS DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1804
Mailing Address - Country:US
Mailing Address - Phone:917-597-3821
Mailing Address - Fax:
Practice Address - Street 1:310 SAINT NICHOLAS AVE STE 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-6568
Practice Address - Country:US
Practice Address - Phone:929-296-6790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR081425-11041C0700X
NY080017-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical