Provider Demographics
NPI:1962781567
Name:LOPEZ, STACEY ROBIN (MA)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:ROBIN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 GRAND ST
Mailing Address - Street 2:APT# E1104
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-4772
Mailing Address - Country:US
Mailing Address - Phone:212-673-4868
Mailing Address - Fax:
Practice Address - Street 1:465 GRAND ST
Practice Address - Street 2:HAND IN HAND DEVELOPMENT,
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4800
Practice Address - Country:US
Practice Address - Phone:212-420-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency