Healthcare Provider Details

I. General information

NPI: 1891053377
Provider Name (Legal Business Name): JOSEPH ANTHONY LOPES LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 E. DRINKER STREET SECOND FLOOR DUNMORE PROFESSIONAL PLAZA
DUNMORE PA
18512-1255
US

IV. Provider business mailing address

629 E DRINKER ST STE 2 DUNMORE PROFESSIONAL BUILDING
DUNMORE PA
18512-2549
US

V. Phone/Fax

Practice location:
  • Phone: 610-212-1744
  • Fax: 570-800-1459
Mailing address:
  • Phone: 610-212-1744
  • Fax: 570-888-1459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW012098
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: