MEDICARE: MR. MARIO REY LOPEZ LSCSW

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
1	1041C0700X	Clinical Social Worker	4214	KS

General Provider Information

NPI Number	:	1619003480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARIO REY LOPEZ LSCSW

Provider Business Mailing Address
First Line	:	2257 SE MOOREFIELD CT
Second Line	:
City	:	TECUMSEH
State	:	KS
Zip	:	66542-9462
Country	:	US
Telephone Number	:	785-969-9222
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 SW GAGE BLVD
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66622-0002
Country	:	US
Telephone Number	:	785-350-3111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	02/18/2023

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