Provider Demographics
NPI:1184223224
Name:CHERYL LOPEZ THERAPY
Entity type:Organization
Organization Name:CHERYL LOPEZ THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:P
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DSW, MS, LCSW-R
Authorized Official - Phone:914-240-6694
Mailing Address - Street 1:732 KING ST
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2345
Mailing Address - Country:US
Mailing Address - Phone:914-231-0389
Mailing Address - Fax:
Practice Address - Street 1:800 WESTCHESTER AVE STE N641
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-1360
Practice Address - Country:US
Practice Address - Phone:914-231-0389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHERYL LOPEZ, LCSW PSYCHOTHERAPY SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-20
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008097451Medicaid
NY1710322391Medicaid