Provider Demographics
NPI:1538625546
Name:LOPEZ, GABRIELA CATALINA (LAC)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:CATALINA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 N JEROME AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08402-1527
Mailing Address - Country:US
Mailing Address - Phone:609-822-1108
Mailing Address - Fax:609-822-1106
Practice Address - Street 1:607 N JEROME AVE
Practice Address - Street 2:
Practice Address - City:MARGATE CITY
Practice Address - State:NJ
Practice Address - Zip Code:08402-1527
Practice Address - Country:US
Practice Address - Phone:609-822-1108
Practice Address - Fax:609-822-1106
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00318300101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0030201Medicaid