Provider Demographics
NPI:1740599356
Name:LOPEZ, JESSICA JOSEPHINE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JOSEPHINE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 NORTHGATE DR
Mailing Address - Street 2:FAMILY SERVICE AGENCY OF MARIN
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3680
Mailing Address - Country:US
Mailing Address - Phone:415-491-5700
Mailing Address - Fax:
Practice Address - Street 1:3000 BRIDGEWAY
Practice Address - Street 2:UNIT 205
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-1489
Practice Address - Country:US
Practice Address - Phone:415-332-3129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health