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General NPI Number Information
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NPI Number | 1194107292
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Entity Type | Individual
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Provider Name | HEATHER ANN LOPEZ LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/24/2015
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Last Update Date | 04/15/2021
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Provider Practice Location Address
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Address Line | 2878 CAMINO DEL RIO S STE 315
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City | SAN DIEGO
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State | CA
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Zip | 92108-3846
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Country | US
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Telephone | 619-340-0417
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Fax |
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Provider Business Mailing Address
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Address Line | 51 W PINE RD
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City | STAATSBURG
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State | NY
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Zip | 12580-5405
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Country | US
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Telephone | 845-206-6834
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 090466
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 101118
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 092088
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License Number State | NY
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