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NPI Code Detail

MEDICARE: WILLOW LOPEZ LMSW

MEDICARE: WILLOW LOPEZ LMSW
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
11041S0200XSchool Social Worker385036NM
2104100000XSocial WorkerM-08290NM

General Provider Information

NPI Number : 1891478467
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLOW LOPEZ LMSW
Provider Business Mailing Address
First Line : PO BOX 2561
Second Line :
City : TAOS
State : NM
Zip : 87571-2561
Country : US
Telephone Number : 575-770-9811
Fax Number :
Provider Business Practice Location Address
First Line : 405 HUNTER ST
Second Line :
City : ESPANOLA
State : NM
Zip : 87532-2656
Country : US
Telephone Number : 505-367-3342
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2023
Last Update Date : 09/12/2023

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Directions to “ WILLOW LOPEZ LMSW” Practice Location

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