Provider Demographics
NPI:1144276940
Name:LOPEZ-WILLIAMS, ANDY (PHD)
Entity type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:LOPEZ-WILLIAMS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 BUSINESS PARK DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6321
Mailing Address - Country:US
Mailing Address - Phone:315-732-3431
Mailing Address - Fax:866-822-2343
Practice Address - Street 1:122 BUSINESS PARK DR
Practice Address - Street 2:SUITE 1
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6321
Practice Address - Country:US
Practice Address - Phone:315-732-3431
Practice Address - Fax:866-822-2343
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017312103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPENDINGMedicaid