Individual provider Active NPI

Marco Lopez, MHC

  • Mental Health Counselor
  • Wantagh, NY
National Provider Identifier
1669209599
Registry record updated Sep 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
01510001 Issued in NY
Practice address
3305 Jerusalem Ave Ste 207
Wantagh, NY 11793-2219
Phone
(516) 785-0323
NPI assigned
Sep 16, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 01510001 NY Primary

Addresses

Primary practice location

3305 Jerusalem Ave Ste 207
Wantagh, NY 11793-2219

Mailing address

3305 Jerusalem Ave Ste 207
Wantagh, NY 11793-2219
Phone (516) 785-0323

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
01510001NYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
South Shore Counseling and Psychological Services P C CurrentSince Sep 23, 2024 Accepting new patients

Locations

3305 Jerusalem Ave
Ste 207
Wantagh, NY 11793
Phone (516) 785-0323

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1726444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1669209599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3305 JERUSALEM AVE STE 207",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117932219",
            "telephone_number": "516-785-0323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3305 JERUSALEM AVE STE 207",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117932219",
            "telephone_number": "516-785-0323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "MARCO",
        "credential": "MHC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-09-16",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "01510001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wantagh, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.