MEDICARE: JAMES A LOPEZ LMHC

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	101YM0800X	Mental Health Counselor	012944	NY

General Provider Information

NPI Number	:	1750092524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES A LOPEZ LMHC

Provider Business Mailing Address
First Line	:	2355 CRESCENT ST # B
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11105-3107
Country	:	US
Telephone Number	:	718-813-0417
Fax Number	:

Provider Business Practice Location Address
First Line	:	2355 CRESCENT ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11105-3107
Country	:	US
Telephone Number	:	718-813-0417
Fax Number	:

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

Provider Enumeration Date	:	12/12/2022
Last Update Date	:	12/12/2022

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