Individual
MIREYA LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3584 JEROME AVE, BRONX, NY 10467-1006
(718) 653-1537
(718) 228-6993
Mailing address
5210 BROADWAY, BRONX, NY 10463-7610
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
34706-T
NY
Other
Enumeration date
02/09/2024
Last updated
03/01/2024
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