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General NPI Number Information
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NPI Number | 1467704684
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Entity Type | Individual
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Provider Name | RICHARD JOSEPH LOPEZ PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2012
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 430 SILLS RD.
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City | YAPHANK
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State | NY
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Zip | 11980-9640
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Country | US
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Telephone | 631-924-5583
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Fax | 631-924-5687
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Provider Business Mailing Address
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Address Line | 342 WHITEHALL ST
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City | LYNBROOK
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State | NY
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Zip | 11563-1049
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Country | US
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Telephone | 516-330-2352
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 019821
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License Number State | NY
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