Healthcare Provider Details

I. General information

NPI: 1730723800
Provider Name (Legal Business Name): MARIA ELENA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRONX CHILD AND FAMILY MENTAL HEALTH CENTER 579 COURTLANDT AVENUE
BRONX NY
10451
US

IV. Provider business mailing address

200 WADSWORTH AVE APT BSMT
NEW YORK NY
10033-3808
US

V. Phone/Fax

Practice location:
  • Phone: 718-485-2100
  • Fax:
Mailing address:
  • Phone: 917-453-4760
  • 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: