Provider Demographics
NPI:1760852750
Name:LOPEZ-SUAREZ, MARISELA
Entity Type:Individual
Prefix:
First Name:MARISELA
Middle Name:
Last Name:LOPEZ-SUAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARISELA
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3000 PARKER RD RM 20
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-2742
Mailing Address - Country:US
Mailing Address - Phone:510-307-4643
Mailing Address - Fax:510-724-8829
Practice Address - Street 1:3000 PARKER RD RM 20
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-2742
Practice Address - Country:US
Practice Address - Phone:510-307-4643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150120277103TS0200X
CAIMF92977106H00000X
CAAMFT133065106H00000X
CALMFT145499106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA150120277OtherSCHOOL PSYCHOLOGIST