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General NPI Number Information
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NPI Number | 1891478467
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Entity Type | Individual
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Provider Name | WILLOW LOPEZ LMSW
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Gender | Female
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Dates
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Enumeration Date | 08/10/2023
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 405 HUNTER ST
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City | ESPANOLA
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State | NM
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Zip | 87532-2656
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Country | US
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Telephone | 505-367-3342
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2561
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City | TAOS
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State | NM
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Zip | 87571-2561
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Country | US
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Telephone | 575-770-9811
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Fax |
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 385036
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | M-08290
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License Number State | NM
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