Provider Demographics
NPI:1811425481
Name:LOPEZ APONTE, LEYNIBEL N (MSWI)
Entity type:Individual
Prefix:
First Name:LEYNIBEL
Middle Name:N
Last Name:LOPEZ APONTE
Suffix:
Gender:F
Credentials:MSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1924
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84091-1924
Mailing Address - Country:US
Mailing Address - Phone:678-982-1328
Mailing Address - Fax:
Practice Address - Street 1:1220 N MAIN ST STE 10
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-4016
Practice Address - Country:US
Practice Address - Phone:801-358-4463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10380399-35061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT10380399-3506Medicaid