Healthcare Provider Details

I. General information

NPI: 1720963424
Provider Name (Legal Business Name): MARIAM LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 LINDSLEY DR STE 300
MORRISTOWN NJ
07960-4456
US

IV. Provider business mailing address

25 LINDSLEY DR STE 300
MORRISTOWN NJ
07960-4456
US

V. Phone/Fax

Practice location:
  • Phone: 973-998-7900
  • Fax:
Mailing address:
  • Phone: 973-998-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37AC00876600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: