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Individual

PRISCILLA C LOPEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MASTER CASAC #34980

Contact information

Practice address
3584 JEROME AVE, BRONX, NY 10467-1006
(653) 153-7718
(699) 371-8228
Mailing address
131 SAINT NICHOLAS AVE APT 2D, NEW YORK, NY 10026-2147
(646) 270-7141

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
211110743
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
11681
NY
Enumeration date
12/12/2019
Last updated
05/16/2024
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