Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
Y | 1041C0700X | Clinical Social Worker | M-10635 | NM |
NPI | 1003233669 |
---|---|
Provider Name | Mariah Lopez |
First Address | Albuquerque, NM 87114-5852 |
Second Address | Albuquerque, NM 87114-5852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2014 |
Last Update Date | 25/08/2020 |