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General NPI Number Information
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NPI Number | 1437901659
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Entity Type | Individual
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Provider Name | AEMIR XOCHITL LOPEZ MEDINA LMSW
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Gender | Female
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Dates
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Enumeration Date | 04/02/2024
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Last Update Date | 04/02/2024
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Provider Practice Location Address
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Address Line | 225 N MAIN ST
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City | BRISTOL
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State | CT
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Zip | 06010-4926
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Country | US
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Telephone | 203-424-3760
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Fax |
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Provider Business Mailing Address
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Address Line | 301 COMMONS PARK S UNIT 511
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City | STAMFORD
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State | CT
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Zip | 06902-7086
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Country | US
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Telephone | 203-424-3760
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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 | 9384
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License Number State | CT
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