Healthcare Provider Details

I. General information

NPI: 1861702839
Provider Name (Legal Business Name): VASCO LOPES PSY D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

362 MINORCA AVE
CORAL GABLES FL
33134-4304
US

IV. Provider business mailing address

362 MINORCA AVE
CORAL GABLES FL
33134-4304
US

V. Phone/Fax

Practice location:
  • Phone: 646-868-5153
  • Fax:
Mailing address:
  • Phone: 646-868-5153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY12605
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number019843-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: