Individual
SERGIO LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
30 FOURTH RD, GREENWOOD LAKE, NY 10925-2510
(845) 537-6908
Mailing address
PO BOX 464, GREENWOOD LAKE, NY 10925-0464
(845) 537-6908
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
37AC00569600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37AC00569600
LICENSE NUMBER
—
Enumeration date
08/12/2021
Last updated
08/12/2021
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