Provider Demographics
NPI:1487035416
Name:LOPEZ, MARIO (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:
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 1:214 N BYRON DR
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-2559
Mailing Address - Country:US
Mailing Address - Phone:559-288-7714
Mailing Address - Fax:559-924-2900
Practice Address - Street 1:214 N BYRON DR
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-2559
Practice Address - Country:US
Practice Address - Phone:559-288-7714
Practice Address - Fax:559-924-2900
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW12363104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker