Provider Demographics
NPI:1730723800
Name:LOPEZ, MARIA ELENA
Entity type:Individual
Prefix:
First Name:MARIA ELENA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WADSWORTH AVE APT BSMT
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3808
Mailing Address - Country:US
Mailing Address - Phone:917-453-4760
Mailing Address - Fax:
Practice Address - Street 1:BRONX CHILD AND FAMILY MENTAL HEALTH CENTER
Practice Address - Street 2:579 COURTLANDT AVENUE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451
Practice Address - Country:US
Practice Address - Phone:718-485-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health