Provider Demographics
NPI:1336297803
Name:DAPO, EDWARD HOWARD III (MSW)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:HOWARD
Last Name:DAPO
Suffix:III
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1027
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-1027
Mailing Address - Country:US
Mailing Address - Phone:505-203-6614
Mailing Address - Fax:
Practice Address - Street 1:119 LUNA AVENUE
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031
Practice Address - Country:US
Practice Address - Phone:505-203-6614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2019-04-04
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2019-04-04
Provider Licenses
StateLicense IDTaxonomies
NM2536801041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool