1992833149 NPI number — RICARDO LOPEZ LCSW

Table of content: RICARDO LOPEZ LCSW (NPI 1992833149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992833149 NPI number — RICARDO LOPEZ LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ
Provider First Name:
RICARDO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992833149
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
66 CANDLE PINE PL # 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THE WOODLANDS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77381-6436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-273-3786
Provider Business Mailing Address Fax Number:
936-273-3786

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2310 BLISS SPILLAR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHACA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78652-4400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-282-3723
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  02897 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 81398W . This is a "BLUE CROSS GROUP NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 038726801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 800009313 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".