Provider Demographics
NPI:1487153821
Name:LOPEZ, LESLEY EMMA (MS)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:EMMA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 HACKMATAC ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-4723
Mailing Address - Country:US
Mailing Address - Phone:631-234-3230
Mailing Address - Fax:
Practice Address - Street 1:600 HEMPSTEAD TPKE STE 120
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1036
Practice Address - Country:US
Practice Address - Phone:516-939-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health