Healthcare Provider Details

I. General information

NPI: 1417368408
Provider Name (Legal Business Name): VANESSA LOPEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 37TH AVE E
BRADENTON FL
34208-4555
US

IV. Provider business mailing address

6209 WILLOW BECK LN APT 208
BRADENTON FL
34202-5096
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-2222
  • Fax:
Mailing address:
  • Phone: 941-792-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW16548
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: