Provider Demographics
NPI:1144064254
Name:LOPEZ, GABRIEL (LMSW)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:GABE
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:321 W 37TH ST APT 7F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-4611
Mailing Address - Country:US
Mailing Address - Phone:323-219-3449
Mailing Address - Fax:
Practice Address - Street 1:330 W 58TH ST STE 305
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1801
Practice Address - Country:US
Practice Address - Phone:323-219-3449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1200821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical