Provider Demographics
NPI:1548540644
Name:LOPEZ, SEBASTIAN (PSY D)
Entity type:Individual
Prefix:DR
First Name:SEBASTIAN
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1903
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-1903
Mailing Address - Country:US
Mailing Address - Phone:787-299-2173
Mailing Address - Fax:787-858-6034
Practice Address - Street 1:URB. EXTENSION OCEAN FRONT, CALLE HARVARD 3512
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-299-2173
Practice Address - Fax:787-858-6034
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4010103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical