MEDICARE: MRS. JENNIFER TERESE GULLO LOPEZ MSW, LCSW

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	8253	LA

General Provider Information

NPI Number	:	1538466933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER TERESE GULLO LOPEZ MSW, LCSW

Provider Business Mailing Address
First Line	:	315 METAIRIE RD STE 201
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70005-4337
Country	:	US
Telephone Number	:	504-905-8310
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 METAIRIE RD STE 201
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70005-4337
Country	:	US
Telephone Number	:	504-905-8310
Fax Number	:

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

Provider Enumeration Date	:	02/21/2011
Last Update Date	:	02/21/2011

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