Myra Dina Lopez, ACSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW96658 Issued in CA

Practice address

15434 W Sage St
Victorville, CA 92392-9751

Phone

(760) 843-0506

Fax

(760) 843-0507

NPI assigned

Jan 29, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• My Deliverance Is Freedom Licensed Clinical Social Worker, Inc

  dba My Deliverance is Freedom, inc

  • Clinical Social Worker
  • Apple Valley, CA
  • NPI 1427712835
  Medicare reassignment NPD Authorized official
• Foothill Behavioral Health Consultants Inc

  • Psychiatry Physician
  • Victorville, CA
  • NPI 1265443154
  Medicare reassignment NPD
• Savanna Olsson, Pmhnp: a Professional Nursing Corporation

  • Nursing Care Agency
  • Victorville, CA
  • NPI 1942955935
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1548720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613174400000",
    "number": "1023572583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15388 LINDEN ST",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923452825",
            "telephone_number": "760-552-9556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15434 W SAGE ST",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923929751",
            "telephone_number": "760-843-0506",
            "fax_number": "760-843-0507"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15248 Eleventh St",
            "address_purpose": "LOCATION",
            "city": "Victorville",
            "state": "CA",
            "postal_code": "923953704",
            "country_code": "US",
            "telephone_number": "760-843-4165",
            "fax_number": "760-843-6188",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "MYRA",
        "middle_name": "DINA",
        "credential": "ACSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-29",
        "last_updated": "2021-02-13",
        "certification_date": "2021-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW96658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madai Lopez
• Maria Lopez
• Maribel Lopez, LVN
• Maximilian Valentine C Lopez
• Melissa Ann Lopez
• Natalia Rachelle Lopez
• Natalie Lopez
• Noah Anthony Lopez
• Tesoro Lizette Lopez
• Denise Lorick

• Clinical Social Worker in Victorville, CA
• Providers in Victorville, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.