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General NPI Number Information
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NPI Number | 1770948457
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Entity Type | Individual
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Provider Name | LORRAINE TAVAREZ LOPEZ LPES
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Gender | Female
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Dates
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Enumeration Date | 12/22/2015
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Last Update Date | 06/08/2024
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Provider Practice Location Address
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Address Line | 1057 OAKLAND DR
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City | ELGIN
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State | SC
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Zip | 29045-9279
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Country | US
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Telephone | 754-779-0584
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Fax |
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Provider Business Mailing Address
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Address Line | 1057 OAKLAND DR
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City | ELGIN
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State | SC
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Zip | 29045-9279
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Country | US
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Telephone | 754-779-0584
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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 | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | 4657
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 4657
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License Number State | SC
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