Provider Demographics
NPI:1225247950
Name:LOPEZ, SUZANNE M (MFCT)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MFCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 LUNA DEL ORO RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1641
Mailing Address - Country:US
Mailing Address - Phone:505-306-8381
Mailing Address - Fax:
Practice Address - Street 1:9100 LUNA DEL ORO RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1641
Practice Address - Country:US
Practice Address - Phone:505-306-8381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0094281106H00000X
CAMFC 21623106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist