Healthcare Provider Details

I. General information

NPI: 1477328458
Provider Name (Legal Business Name): ARMANDO REYES LOPEZ MCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 STAFFORD ST STE 209
WORCESTER MA
01603-1454
US

IV. Provider business mailing address

933 E COLUMBUS AVE
SPRINGFIELD MA
01105-2509
US

V. Phone/Fax

Practice location:
  • Phone: 508-762-1331
  • Fax:
Mailing address:
  • Phone: 413-736-8329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: