MEDICARE: STEPHANIE LOPEZ, LLC

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

General Provider Information

NPI Number	:	1801297668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHANIE LOPEZ, LLC

Provider Business Mailing Address
First Line	:	3040 RIVERSIDE DR
Second Line	:	SUITE 202
City	:	COLUMBUS
State	:	OH
Zip	:	43221-2551
Country	:	US
Telephone Number	:	614-725-2772
Fax Number	:

Provider Business Practice Location Address
First Line	:	3040 RIVERSIDE DR
Second Line	:	SUITE 202
City	:	COLUMBUS
State	:	OH
Zip	:	43221-2551
Country	:	US
Telephone Number	:	614-725-2772
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	STEPHANIE LOPEZ
Credential	:	LISW-S
Telephone Number	:	614-725-2772

Provider Enumeration Date	:	09/11/2014
Last Update Date	:	09/11/2014

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