Provider Demographics
NPI:1063700649
Name:LOPUSNAK, MARY E (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:LOPUSNAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:FL
Mailing Address - Zip Code:33576-0284
Mailing Address - Country:US
Mailing Address - Phone:813-713-9402
Mailing Address - Fax:813-283-1184
Practice Address - Street 1:33913 STATE ROAD 54
Practice Address - Street 2:#102
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-9176
Practice Address - Country:US
Practice Address - Phone:813-713-9402
Practice Address - Fax:813-713-9402
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW102831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical