Provider Demographics
NPI:1760203491
Name:LOPEZ, STEFANO (LSW)
Entity type:Individual
Prefix:
First Name:STEFANO
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 MIDLAND AVE APT 3D
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-1758
Mailing Address - Country:US
Mailing Address - Phone:973-607-9597
Mailing Address - Fax:
Practice Address - Street 1:365 W PASSAIC ST STE 112
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3017
Practice Address - Country:US
Practice Address - Phone:201-423-6305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07074000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker