Provider Demographics
NPI:1063997195
Name:LOPES, MARY KRISTINE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KRISTINE
Last Name:LOPES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 NE LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-3066
Mailing Address - Country:US
Mailing Address - Phone:971-238-4408
Mailing Address - Fax:971-238-8061
Practice Address - Street 1:239 NE LINCOLN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-3066
Practice Address - Country:US
Practice Address - Phone:971-238-4408
Practice Address - Fax:971-238-8061
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker