Basic Information
| Provider Information | |||||||||
| NPI: | 1245404904 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOPEZ | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | ELENA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2805 FOUNTAIN PLAZA BLVD. | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785398031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563162224 | ||||||||
| FaxNumber: | 9563162224 | ||||||||
| Practice Location | |||||||||
| Address1: | 2715 W. TRENTON RD. | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785393433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566831155 | ||||||||
| FaxNumber: | 9566831188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2008 | ||||||||
| LastUpdateDate: | 08/15/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 32660 | TX | Y | Behavioral Health & Social Service Providers | Social Worker | 171M00000X | 32660 | TX | N | Other Service Providers | Case Manager/Care Coordinator |
ID Information
| ID | Type | State | Issuer | Description | 32660 | 01 | TX | SOCIAL WORK EXAMINERS | OTHER |