Ivan Ricardo Lopez, LCSW
Social Worker, Clinical in Bristol, FL. Individual provider (NPI-1).
NPI number1164058756
StatusActive
Last updated in NPPESMar 16, 2020
Details
- NPI
- 1164058756
- Entity type
- Individual (NPI-1)
- Name
- Ivan Ricardo Lopez
- Credential
- LCSW
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 16, 2020
- Certification date
- Mar 16, 2020
- Last updated
- Mar 16, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 16852 | FL | Yes |
Practice location
11033 Nw State Road 20Bristol, FL 32321-6406
Phone 850-643-1155
Mailing address
5001 Lake Front Dr Apt B1Tallahassee, FL 32303-7171
Phone 863-216-9151
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