Ivan Ricardo Lopez, LCSW

NPI #1164058756 in Bristol, Florida

Provider Information

NPI Number
1164058756
Entity Type
Individual
Name
Ivan Ricardo Lopez, LCSW
Gender
Not Specified
Sole Proprietor
No
Primary Specialty
Social Worker - Clinical
Credential
LCSW
Enumeration Date
Mar 16, 2020
Last Updated
Mar 16, 2020

Practice Location

Address
11033 NW STATE ROAD 20
State
Florida
ZIP Code
32321-6406
Phone
(850) 643-1155

Specialties & Taxonomy Codes

Specialty
Social Worker - ClinicalClinical

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