Healthcare Provider Details

I. General information

NPI: 1972865053
Provider Name (Legal Business Name): MARIA VANESSA LOPEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 GEORGE ST SUITE 200
NEW BRUNSWICK NJ
08901-2020
US

IV. Provider business mailing address

303 GEORGE ST SUITE 200
NEW BRUNSWICK NJ
08901-2020
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-6800
  • Fax:
Mailing address:
  • Phone: 732-235-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL05663400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05557900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: