=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104630193
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LA-ELEYA LOPEZ LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2025
-----------------------------------------------------
Last Update Date | 02/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 WINDEMERE LN
-----------------------------------------------------
City | LANDISVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17538-1560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-315-4371
-----------------------------------------------------
Fax | 833-946-3162
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 WINDEMERE LN
-----------------------------------------------------
City | LANDISVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17538-1560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-315-4371
-----------------------------------------------------
Fax | 833-946-3162
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | SW142216
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------