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Individual
MARY LOPEZ
Active
Individual
MARY LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018872
—
NJ
Enumeration date
05/07/2010
Last updated
08/29/2014
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