Provider Demographics
NPI:1053119164
Name:MARITZA LOPEZ CAMPOS PLLC
Entity type:Organization
Organization Name:MARITZA LOPEZ CAMPOS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ CAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:712-204-8578
Mailing Address - Street 1:2030 W 23RD ST REAR BUILDING
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-4129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2030 W 23RD ST REAR BUILDING
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-4129
Practice Address - Country:US
Practice Address - Phone:712-204-8578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health