Provider Demographics
NPI:1205994357
Name:LOPEZ, MARY HELEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY HELEN
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
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:PO BOX 2433
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635
Mailing Address - Country:US
Mailing Address - Phone:209-827-6998
Mailing Address - Fax:209-827-6998
Practice Address - Street 1:242 I ST
Practice Address - Street 2:#2
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635
Practice Address - Country:US
Practice Address - Phone:831-635-0100
Practice Address - Fax:831-636-3748
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA215751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5619048OtherFIRST HEALTH
CALCS215751OtherBLUE SHIELD OF CA
CA11491864OtherCAQH
CA597A62525OtherBC LIFE & HEALTH INS CO
CALCS215750OtherBLUE SHIELD OF CA