Healthcare Provider Details

I. General information

NPI: 1689227027
Provider Name (Legal Business Name): AILI ANAIS LOPEZ LMHC, ATR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 WING RD
GREENFIELD CENTER NY
12833
US

IV. Provider business mailing address

110 WING RD
GREENFIELD CENTER NY
12833-1664
US

V. Phone/Fax

Practice location:
  • Phone: 518-888-4046
  • Fax:
Mailing address:
  • Phone: 518-888-4046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number007442
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: