Provider Demographics
NPI:1124765326
Name:LOPEZ BARBOSA, JOSMARY (MCSW)
Entity type:Individual
Prefix:
First Name:JOSMARY
Middle Name:
Last Name:LOPEZ BARBOSA
Suffix:
Gender:F
Credentials:MCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:867 CALLE MENTA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-2537
Mailing Address - Country:US
Mailing Address - Phone:787-974-2124
Mailing Address - Fax:
Practice Address - Street 1:867 CALLE MENTA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-2537
Practice Address - Country:US
Practice Address - Phone:787-974-2124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR118871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty