Provider Demographics
NPI:1376057190
Name:LARA LOPEZ, MARICRUZ (LSW)
Entity Type:Individual
Prefix:
First Name:MARICRUZ
Middle Name:
Last Name:LARA LOPEZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:MARICRUZ
Other - Middle Name:
Other - Last Name:LARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSW
Mailing Address - Street 1:6512 S MCCARRAN BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6141
Mailing Address - Country:US
Mailing Address - Phone:775-788-7600
Mailing Address - Fax:
Practice Address - Street 1:6512 S MCCARRAN BLVD STE A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6141
Practice Address - Country:US
Practice Address - Phone:775-788-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7627-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker