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NPI Code Detail

MEDICARE: STACY LOPEZ LGSW

MEDICARE:   STACY  LOPEZ  LGSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerBP00944341WV
21041C0700XClinical Social WorkerBP00944341WV

General Provider Information

NPI Number : 1376931287
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY LOPEZ LGSW
Provider Business Mailing Address
First Line : 235 S. WATER ST
Second Line :
City : MARTINSBURG
State : WV
Zip : 25401-0000
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 300 FOXCROFT AVE STE 100B-6
Second Line :
City : MARTINSBURG
State : WV
Zip : 25401-5341
Country : US
Telephone Number : 304-240-2698
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2014
Last Update Date : 02/28/2022

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Directions to “ STACY LOPEZ LGSW” Practice Location

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