Provider Demographics
NPI:1104228477
Name:LOPEZ, JESSICA DIANE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:DIANE
Last Name:LOPEZ
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 1:17288 E TRAILMASTER DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-4354
Mailing Address - Country:US
Mailing Address - Phone:505-710-3060
Mailing Address - Fax:
Practice Address - Street 1:19590 E MAINSTREET STE 202
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-7371
Practice Address - Country:US
Practice Address - Phone:505-710-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMB-07662104100000X
COCSW.09926272104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker