MEDICARE: MRS. CORINNE LOPEZ QP,MSW,LCSW-A

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
1	1041C0700X	Clinical Social Worker	P016561	NC

General Provider Information

NPI Number	:	1548938376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CORINNE LOPEZ QP,MSW,LCSW-A

Provider Business Mailing Address
First Line	:	602 YOUNG FOREST DR
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-7177
Country	:	US
Telephone Number	:	631-747-3416
Fax Number	:

Provider Business Practice Location Address
First Line	:	1823 CHAPEL HILL RD
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-1100
Country	:	US
Telephone Number	:	631-747-3416
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2021
Last Update Date	:	09/06/2021

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