Provider Demographics
NPI:1912152141
Name:LOPEZ, ROZANA MARLAINE BATES (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ROZANA MARLAINE
Middle Name:BATES
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 1:501 AIRPORT DR STE 253
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-2646
Mailing Address - Country:US
Mailing Address - Phone:505-325-2778
Mailing Address - Fax:505-325-6171
Practice Address - Street 1:501 AIRPORT DR STE 253
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-2646
Practice Address - Country:US
Practice Address - Phone:505-325-2778
Practice Address - Fax:505-325-6171
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-068631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical