Provider Demographics
NPI:1518043843
Name:LOPEZ, ANNA KARINA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:KARINA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 26TH STREET
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-3105
Mailing Address - Country:US
Mailing Address - Phone:801-625-3605
Mailing Address - Fax:801-625-3615
Practice Address - Street 1:237 26TH STREET
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-3105
Practice Address - Country:US
Practice Address - Phone:801-625-3605
Practice Address - Fax:801-625-3615
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5116562-3501101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
260022408OtherRAILROAD MEDICARE
260022408OtherRAILROAD MEDICARE