=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104704238
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA DEL CISNE LOPEZ LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2025
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 76 CLINTON AVE
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07114-2012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 848-216-6866
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2513
-----------------------------------------------------
City | SECAUCUS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07096-2513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 44SL07193700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------