Provider Demographics
NPI:1568094613
Name:LOPEZ, JEANNIE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANNIE
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JEANNE-MARIE
Other - Middle Name:M
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:700 YGNACIO VALLEY RD STE 320
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3838
Mailing Address - Country:US
Mailing Address - Phone:925-939-7500
Mailing Address - Fax:
Practice Address - Street 1:700 YGNACIO VALLEY RD STE 320
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3838
Practice Address - Country:US
Practice Address - Phone:925-939-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18357103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical