Provider Demographics
NPI:1578204996
Name:LOPEZ, LISESTH (LMSW)
Entity Type:Individual
Prefix:
First Name:LISESTH
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 E INDIAN SCHOOL RD STE 1005
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5469
Mailing Address - Country:US
Mailing Address - Phone:623-244-9401
Mailing Address - Fax:
Practice Address - Street 1:6125 E INDIAN SCHOOL RD STE 1005
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5469
Practice Address - Country:US
Practice Address - Phone:623-244-9401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-168461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty