Provider Demographics
NPI:1053169508
Name:LOPEZ-CAMPOS, MARITZA (LCSW)
Entity type:Individual
Prefix:
First Name:MARITZA
Middle Name:
Last Name:LOPEZ-CAMPOS
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 1:2030 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:712-204-8578
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:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical