Provider Demographics
NPI:1629951884
Name:LOPEZ, AMBERLY
Entity type:Individual
Prefix:
First Name:AMBERLY
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 BOSTON RD APT 1L
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-6739
Mailing Address - Country:US
Mailing Address - Phone:347-822-3296
Mailing Address - Fax:
Practice Address - Street 1:2001 PALMER AVE STE 205
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-2420
Practice Address - Country:US
Practice Address - Phone:917-979-8736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health