Healthcare Provider Details

I. General information

NPI: 1477798874
Provider Name (Legal Business Name): AIDA LOPEZ GREENSPUN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2008
Last Update Date: 12/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 SOUTH DR
EAST BRUNSWICK NJ
08816-1133
US

IV. Provider business mailing address

PO BOX 844
MILLTOWN NJ
08850-0844
US

V. Phone/Fax

Practice location:
  • Phone: 732-735-1596
  • Fax:
Mailing address:
  • Phone: 732-257-2023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC01469400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: