MEDICARE: MS. LEAH MARIE LOPEZ LCSW

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	69163	TX

General Provider Information

NPI Number	:	1831962166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LEAH MARIE LOPEZ LCSW

Provider Business Mailing Address
First Line	:	12838 COAL MINE RISE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-3557
Country	:	US
Telephone Number	:	210-758-8120
Fax Number	:

Provider Business Practice Location Address
First Line	:	12838 COAL MINE RISE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-3557
Country	:	US
Telephone Number	:	210-758-8120
Fax Number	:

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

Provider Enumeration Date	:	10/30/2023
Last Update Date	:	10/30/2023

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