Provider Demographics
NPI:1740781814
Name:LOPEZ, STELLA L (LMSW)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:L
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 1:12009 ELVIN PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-3460
Mailing Address - Country:US
Mailing Address - Phone:505-846-3562
Mailing Address - Fax:
Practice Address - Street 1:2050A SECOND STREET SE
Practice Address - Street 2:377 MDG/SGHN
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87117-5522
Practice Address - Country:US
Practice Address - Phone:505-846-3562
Practice Address - Fax:505-503-7947
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-094691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical