MEDICARE: MS. NILZA LOPEZ LMSW

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	104100000X	Social Worker	048430-1	NY

General Provider Information

NPI Number	:	1316191315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NILZA LOPEZ LMSW

Provider Business Mailing Address
First Line	:	3728 BRONX BLVD
Second Line	:	PH
City	:	BRONX
State	:	NY
Zip	:	10467
Country	:	US
Telephone Number	:	347-678-4963
Fax Number	:	347-678-4963

Provider Business Practice Location Address
First Line	:	3728 BRONX BLVD
Second Line	:	PH
City	:	BRONX
State	:	NY
Zip	:	10467-5403
Country	:	US
Telephone Number	:	347-678-4963
Fax Number	:	347-678-4963

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

Provider Enumeration Date	:	11/05/2008
Last Update Date	:	11/05/2008

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