Individual
GLENDA LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
539 BROAD HOLLOW RD, SUITE 202, FARMINGDALE, NY 11735
(631) 385-7780
Mailing address
4 BURWOOD LN, CORAM, NY 11727
(917) 445-0905
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/24/2015
Last updated
09/24/2015
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