Provider Demographics
NPI:1730255746
Name:LOPEZ, CHARLES A (LPC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:A
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1316
Mailing Address - Country:US
Mailing Address - Phone:973-309-0952
Mailing Address - Fax:973-912-0103
Practice Address - Street 1:407 ESSEX ST
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1316
Practice Address - Country:US
Practice Address - Phone:973-309-0952
Practice Address - Fax:973-912-0103
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00366500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional