Provider Demographics
NPI:1952122772
Name:LOPEZ, KATHY M
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5627 N 62ND DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-5729
Mailing Address - Country:US
Mailing Address - Phone:602-526-9350
Mailing Address - Fax:
Practice Address - Street 1:5627 N 62ND DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-5729
Practice Address - Country:US
Practice Address - Phone:602-526-9350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker