Individual
MANDY LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
6330 RIVERSIDE PLAZA LN NW STE 260, ALBUQUERQUE, NM 87120-2160
(505) 226-2839
Mailing address
2710 BLUE MOON DR NE, RIO RANCHO, NM 87144-4145
(505) 901-0120
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C-09467
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05852820
—
NM
01
—
13583510
CA QH#
NM
Enumeration date
02/10/2014
Last updated
01/31/2019
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