Provider Demographics
NPI:1326280322
Name:LOZANO, ILMA MARINA (LSWA-MSW)
Entity Type:Individual
Prefix:
First Name:ILMA
Middle Name:MARINA
Last Name:LOZANO
Suffix:
Gender:F
Credentials:LSWA-MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 BEECH ST
Mailing Address - Street 2:RIVER VALLEY COUNSELING CENTER
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040
Mailing Address - Country:US
Mailing Address - Phone:413-540-1100
Mailing Address - Fax:413-534-7158
Practice Address - Street 1:303 BEECH ST
Practice Address - Street 2:RIVER VALLEY COUNSELING CENTER
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040
Practice Address - Country:US
Practice Address - Phone:413-540-1100
Practice Address - Fax:413-534-7158
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA400197104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker