Provider Demographics
NPI:1295176303
Name:CANTOR-LOPEZ, LETICIA (ACSW)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:CANTOR-LOPEZ
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:CA
Mailing Address - Zip Code:93640-8232
Mailing Address - Country:US
Mailing Address - Phone:855-343-1057
Mailing Address - Fax:
Practice Address - Street 1:121 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:CA
Practice Address - Zip Code:93640-8232
Practice Address - Country:US
Practice Address - Phone:855-343-1057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1143571041C0700X
CA888901041C0700X, 101YM0800X
CA359361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical