Individual
MARISELA LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LP
Contact information
Practice address
66 TRUMBULL ST # 1FF, NEW HAVEN, CT 06510-1012
(414) 436-9080
Mailing address
14 TRUMBULL ST APT 302, NEW HAVEN, CT 06511-6312
(414) 702-3148
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
003763
CT
Other
Enumeration date
01/19/2019
Last updated
01/19/2019
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