Provider Demographics
NPI:1962764225
Name:LOPEZ, LOURDES RAQUEL (MS SP ED)
Entity type:Individual
Prefix:MS
First Name:LOURDES
Middle Name:RAQUEL
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MS SP ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1422
Mailing Address - Country:US
Mailing Address - Phone:917-496-5863
Mailing Address - Fax:
Practice Address - Street 1:81 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1422
Practice Address - Country:US
Practice Address - Phone:917-496-5863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist