Provider Demographics
NPI:1790024289
Name:LOPEZ SIERRA, SUSANA (MSW)
Entity type:Individual
Prefix:MRS
First Name:SUSANA
Middle Name:
Last Name:LOPEZ SIERRA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:SUSANA
Other - Middle Name:
Other - Last Name:SIERRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:122 SW CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-4327
Mailing Address - Country:US
Mailing Address - Phone:561-373-0880
Mailing Address - Fax:
Practice Address - Street 1:122 SW CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-4327
Practice Address - Country:US
Practice Address - Phone:561-373-0880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker