MEDICARE: NOEL LOPEZ BCBA

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1538536909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOEL LOPEZ BCBA

Provider Business Mailing Address
First Line	:	2849 N DAMEN AVE UNIT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-8421
Country	:	US
Telephone Number	:	773-307-5296
Fax Number	:

Provider Business Practice Location Address
First Line	:	2849 N DAMEN AVE UNIT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-8421
Country	:	US
Telephone Number	:	773-307-5296
Fax Number	:

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

Provider Enumeration Date	:	09/01/2015
Last Update Date	:	11/10/2023

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