Provider Demographics
NPI:1871124750
Name:LOPEZ, LILIBETH ELISA
Entity type:Individual
Prefix:
First Name:LILIBETH
Middle Name:ELISA
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 1:817 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-2722
Mailing Address - Country:US
Mailing Address - Phone:585-256-8900
Mailing Address - Fax:
Practice Address - Street 1:214 CLIFFORD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-5304
Practice Address - Country:US
Practice Address - Phone:585-544-7064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator