Individual
DR. HEATHER L. LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
155 LOG CANOE CIR, STEVENSVILLE, MD 21666-2127
(410) 604-0226
Mailing address
155 LOG CANOE CIR, STEVENSVILLE, MD 21666-2127
(410) 604-0226
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
05314
MD
103TC0700X
Clinical Psychologist
B1-0001028
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0685631 00
—
MD
01
—
4607871
CIGNA
—
01
—
600810391
MAGELLAN MIS
—
01
—
V338-0008
CAREFIRST BLUECROSS BLUESHIELD
—
Enumeration date
12/20/2012
Last updated
02/17/2016
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