Provider Demographics
NPI:1700981412
Name:LOPEZ, MARIANNE REDMOND (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:REDMOND
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 1:43 TOWN AND COUNTRY DR
Mailing Address - Street 2:SUITE #143
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-8729
Mailing Address - Country:US
Mailing Address - Phone:703-862-5679
Mailing Address - Fax:
Practice Address - Street 1:12200 AMOS LN
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-7107
Practice Address - Country:US
Practice Address - Phone:703-862-5679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904004604104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
3878OtherCAREFIRST BC
VA212387OtherSOUTHEAST
512389OtherNCPPO
087841OtherSENTARA
441745OtherANTHEM BC
468354OtherVALUE OPTIONS
350821000OtherMAGELLAN
730S414OtherAETNA
VA8937621Medicaid
VAP55562Medicare UPIN
512389OtherNCPPO