Provider Demographics
NPI:1639399702
Name:LOPEZ, GREGORIA (LBSW)
Entity Type:Individual
Prefix:
First Name:GREGORIA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LBSW
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 2185
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-7185
Mailing Address - Country:US
Mailing Address - Phone:956-279-5660
Mailing Address - Fax:
Practice Address - Street 1:3 MILES N. CESAR CHAVEZ ROAD, 1 4 W MINNESOTA ROAD
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589
Practice Address - Country:US
Practice Address - Phone:956-781-4904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16082104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker