MEDICARE: ESTELA LOPEZ-ESPELIN LCSW, MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	10717	CT

General Provider Information

NPI Number	:	1245880418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTELA LOPEZ-ESPELIN LCSW, MA

Provider Business Mailing Address
First Line	:	781 BOSTON POST RD UNIT 321
Second Line	:
City	:	MADISON
State	:	CT
Zip	:	06443-7706
Country	:	US
Telephone Number	:	203-244-8363
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 DURHAM RD STE 6
Second Line	:
City	:	MADISON
State	:	CT
Zip	:	06443-2656
Country	:	US
Telephone Number	:	203-244-8363
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2019
Last Update Date	:	09/17/2022

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