MEDICARE: CHRISTINA 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	1041C0700X	Clinical Social Worker	3586	CT

General Provider Information

NPI Number	:	1730626136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA LOPEZ LMSW

Provider Business Mailing Address
First Line	:	514 CLEVELAND AVE
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06604-1603
Country	:	US
Telephone Number	:	203-583-6999
Fax Number	:

Provider Business Practice Location Address
First Line	:	514 CLEVELAND AVE
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06604-1603
Country	:	US
Telephone Number	:	203-583-6999
Fax Number	:

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

Provider Enumeration Date	:	01/23/2017
Last Update Date	:	01/23/2017

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