Provider Demographics
NPI:1104034768
Name:LOPEZ, MARCUS GREGORY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:GREGORY
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 S C ST STE C
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-4573
Mailing Address - Country:US
Mailing Address - Phone:805-385-9452
Mailing Address - Fax:805-985-9401
Practice Address - Street 1:2500 S C ST STE C
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-4573
Practice Address - Country:US
Practice Address - Phone:805-385-9452
Practice Address - Fax:805-385-9401
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA626831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health