Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003342312 |
---|---|
Provider Name | David Lopez |
First Address | Chelsea, MA 02150-2807 |
Second Address | Chelsea, MA 02150-2807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2017 |
Last Update Date | 05/05/2017 |