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General NPI Number Information
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NPI Number | 1255897146
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Entity Type | Individual
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Provider Name | STANLEY M. LOPEZ I CASAC II
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Gender | Male
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Dates
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Enumeration Date | 02/15/2019
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Last Update Date | 02/15/2019
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Provider Practice Location Address
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Address Line | 214 W 116TH ST
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City | NEW YORK
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State | NY
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Zip | 10026-2494
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Country | US
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Telephone | 212-602-1400
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Fax | 212-602-1895
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Provider Business Mailing Address
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Address Line | 3985 GOUVERNEUR AVE
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City | BRONX
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State | NY
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Zip | 10463-2939
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Country | US
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Telephone | 917-650-7032
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Fax | 212-602-1895
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 8100
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License Number State | NY
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