Provider Demographics
NPI:1194087692
Name:LOPEZ, JUANITA DOLORES (MASTER OF SOCIAL WOR)
Entity type:Individual
Prefix:MS
First Name:JUANITA
Middle Name:DOLORES
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MASTER OF SOCIAL WOR
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4851 INDEPENDENCE STREET SUITE 200
Mailing Address - Street 2:JEFFERSON CENTER FOR MENTAL HEALTH
Mailing Address - City:WHEATRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6715
Mailing Address - Country:US
Mailing Address - Phone:303-425-0300
Mailing Address - Fax:303-432-5071
Practice Address - Street 1:4851 INDEPENDENCE ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:WHEATRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6715
Practice Address - Country:US
Practice Address - Phone:303-425-0300
Practice Address - Fax:303-432-5071
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health