Provider Demographics
NPI:1922018043
Name:LOPEZ, JEANETTE LOUISE TAMBERI (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:LOUISE TAMBERI
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JEANETTE
Other - Middle Name:LOUISE
Other - Last Name:TAMBERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6272 N DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0868
Mailing Address - Country:US
Mailing Address - Phone:559-449-1631
Mailing Address - Fax:559-439-2542
Practice Address - Street 1:2008 N FINE AVE
Practice Address - Street 2:STE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1564
Practice Address - Country:US
Practice Address - Phone:559-449-1631
Practice Address - Fax:559-439-2542
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS14542104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ30995ZMedicare ID - Type Unspecified