Healthcare Provider Details

I. General information

NPI: 1508299652
Provider Name (Legal Business Name): DAISY LOPEZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 COURTLANDT AVE
BRONX NY
10451-5013
US

IV. Provider business mailing address

202 SEMINARY AVE
YONKERS NY
10704-1825
US

V. Phone/Fax

Practice location:
  • Phone: 718-485-2100
  • Fax: 718-485-2101
Mailing address:
  • Phone: 914-433-7195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: