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NPI Code Detail

MEDICARE: MS. MARIANNE LOPEZ LCPC

MEDICARE: MS. MARIANNE LOPEZ LCPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor180.015420IL

General Provider Information

NPI Number : 1417687690
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARIANNE LOPEZ LCPC
Provider Business Mailing Address
First Line : 1130 S CANAL ST # 1291
Second Line :
City : CHICAGO
State : IL
Zip : 60607-4907
Country : US
Telephone Number : 773-230-8438
Fax Number :
Provider Business Practice Location Address
First Line : 1653 W 35TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60609-1309
Country : US
Telephone Number : 312-487-1878
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2022
Last Update Date : 11/29/2023

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