Provider Demographics
NPI:1942570882
Name:LOPEZ, RUTH JOHANNA (LIC)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:JOHANNA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. SABANERA DORADO
Mailing Address - Street 2:# 484 CAMINO EL YUNQUE
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-3640
Mailing Address - Country:US
Mailing Address - Phone:787-960-4748
Mailing Address - Fax:787-946-4414
Practice Address - Street 1:URB. SABANERA DORADO
Practice Address - Street 2:# 484 CAMINO EL YUNQUE
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-960-4748
Practice Address - Fax:787-796-8529
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X, 103T00000X, 103TA0700X, 103TB0200X, 103TF0000X, 103TR0400X
PR4134103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation