Individual
GIOVAN EDNUELLE GABRIEL LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
877 SOUTH ST, PITTSFIELD, MA 01201-8242
(413) 236-5656
Mailing address
877 SOUTH ST, PITTSFIELD, MA 01201-8242
(413) 236-5656
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
12/19/2018
Last updated
12/19/2018
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