Provider Demographics
NPI:1922730407
Name:LOPEZ MONTALVO, YARIS L (MSW)
Entity Type:Individual
Prefix:
First Name:YARIS
Middle Name:L
Last Name:LOPEZ MONTALVO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:YARIS
Other - Middle Name:L
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:URB. JESUS MARIA LAGO
Mailing Address - Street 2:F4 CALLE MARGARITA ESTEVA
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641
Mailing Address - Country:US
Mailing Address - Phone:787-314-8582
Mailing Address - Fax:
Practice Address - Street 1:URB. JESUS MARIA LAGO
Practice Address - Street 2:F4 CALLE MARGARITA ESTEVA
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641
Practice Address - Country:US
Practice Address - Phone:787-314-8582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR130681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical