Healthcare Provider Details

I. General information

NPI: 1053221192
Provider Name (Legal Business Name): SAMANTHA DANIELLE LOPEZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W LAS CRUCES AVE
LAS CRUCES NM
88005-1804
US

IV. Provider business mailing address

11607 PELLICANO DR APT 1808
EL PASO TX
79936-6620
US

V. Phone/Fax

Practice location:
  • Phone: 575-249-0390
  • Fax:
Mailing address:
  • Phone: 915-352-8737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number120235
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2026-1232
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: