Healthcare Provider Details

I. General information

NPI: 1043140304
Provider Name (Legal Business Name): KIMBERLY LOPEZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNION ST FL 3
BOSTON MA
02108-2421
US

IV. Provider business mailing address

771 E 5TH ST APT 1
SOUTH BOSTON MA
02127-3200
US

V. Phone/Fax

Practice location:
  • Phone: 617-865-9286
  • Fax:
Mailing address:
  • Phone: 803-201-5370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: