Provider Demographics
NPI:1538536909
Name:LOPEZ, NOEL (BCBA)
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2849 N DAMEN AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-8421
Mailing Address - Country:US
Mailing Address - Phone:773-307-5296
Mailing Address - Fax:
Practice Address - Street 1:2849 N DAMEN AVE UNIT 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-8421
Practice Address - Country:US
Practice Address - Phone:773-307-5296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health