Provider Demographics
NPI:1568432326
Name:LOPEZ, BEN LAWRENCE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BEN
Middle Name:LAWRENCE
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 1:3765 GRASS VALLEY HWY #252
Mailing Address - Street 2:STE 9
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-2036
Mailing Address - Country:US
Mailing Address - Phone:530-887-8220
Mailing Address - Fax:530-885-2205
Practice Address - Street 1:3765 GRASS VALLEY HWY #252
Practice Address - Street 2:STE 9
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2036
Practice Address - Country:US
Practice Address - Phone:530-887-8220
Practice Address - Fax:530-885-2205
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS006151104100000X
CA0061511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker