Provider Demographics
NPI:1992833149
Name:LOPEZ, RICARDO (LCSW)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 CANDLE PINE PL # 100
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-6436
Mailing Address - Country:US
Mailing Address - Phone:936-273-3786
Mailing Address - Fax:936-273-3786
Practice Address - Street 1:2310 BLISS SPILLAR RD
Practice Address - Street 2:
Practice Address - City:MANCHACA
Practice Address - State:TX
Practice Address - Zip Code:78652-4400
Practice Address - Country:US
Practice Address - Phone:512-282-3723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX028971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81398WOtherBLUE CROSS GROUP NUMBER
TX038726801Medicaid
TX800009313OtherRAILROAD MEDICARE
TX81398WMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER