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General NPI Number Information
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NPI Number | 1538448865
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Entity Type | Individual
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Provider Name | BLANCA LUCILLE LOPEZ
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Gender | Female
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Dates
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Enumeration Date | 08/04/2011
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 2355 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60608-3837
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Country | US
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Telephone | 773-254-1400
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Fax | 773-650-1239
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Provider Business Mailing Address
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Address Line | 966 W 21ST ST
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City | CHICAGO
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State | IL
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Zip | 60608-4511
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Country | US
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Telephone | 773-254-1400
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Fax | 773-650-1239
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149018185
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License Number State | IL
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