1710154885 NPI number — CLARENA LOPEZ MCBETH LMHC, CASAC, LPC

Table of content: CLARENA LOPEZ MCBETH LMHC, CASAC, LPC (NPI 1710154885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710154885 NPI number — CLARENA LOPEZ MCBETH LMHC, CASAC, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCBETH
Provider First Name:
CLARENA
Provider Middle Name:
LOPEZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC, CASAC, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOPEZ
Provider Other First Name:
CLARENA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710154885
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28 LAFAYETTE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWICH
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06830-5440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-307-2370
Provider Business Mailing Address Fax Number:
203-307-2370

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28 LAFAYETTE PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWICH
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06830-5440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-307-2370
Provider Business Practice Location Address Fax Number:
203-307-2370
Provider Enumeration Date:
05/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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