Provider Demographics
NPI:1649388950
Name:LOPEZ, SYLVIA IBARRA (LBSW)
Entity Type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:IBARRA
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 1:336 LOWER RED ROCK RD
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-3261
Mailing Address - Country:US
Mailing Address - Phone:512-873-6309
Mailing Address - Fax:
Practice Address - Street 1:336 LOWER RED ROCK RD
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3261
Practice Address - Country:US
Practice Address - Phone:512-873-6309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical