Healthcare Provider Details

I. General information

NPI: 1629973748
Provider Name (Legal Business Name): ASHLY LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1124 PATRIOT WAY
EASTAMPTON NJ
08060-9624
US

IV. Provider business mailing address

921 PENN ST
CAMDEN NJ
08102-1035
US

V. Phone/Fax

Practice location:
  • Phone: 856-492-1355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: