Provider Demographics
NPI:1437314093
Name:SON, JOSEPHINE LOPEZ (LCSW)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:LOPEZ
Last Name:SON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:L
Other - Last Name:SON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:P.O. BOX 1471
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93258-1471
Mailing Address - Country:US
Mailing Address - Phone:559-213-5849
Mailing Address - Fax:559-781-7353
Practice Address - Street 1:303 W HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-1732
Practice Address - Country:US
Practice Address - Phone:559-306-9753
Practice Address - Fax:559-213-5849
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 235391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical