Individual
KATHLEEN LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC
Contact information
Practice address
3584 JEROME AVE, BRONX, NY 10467-1006
(718) 653-1537
(718) 882-1426
Mailing address
PO BOX 417147, BOSTON, MA 02241-7147
(518) 952-8140
(518) 952-8287
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
21577
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03008211
—
NY
Enumeration date
02/01/2012
Last updated
02/01/2012
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