Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 011094 | NY |
Y | 103T00000X | Psychologist | 011094 | NY |
NPI | 1003193707 |
---|---|
Provider Name | Dr. Linda Marie Lopez |
First Address | Greenvale, NY 11548-1104 |
Second Address | Greenvale, NY 11548-1104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2011 |
Last Update Date | 08/11/2011 |