Provider Demographics
NPI:1700253986
Name:LOPEZ, VANESSA (LMFT 119968)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LMFT 119968
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-5857
Mailing Address - Country:US
Mailing Address - Phone:323-599-3047
Mailing Address - Fax:
Practice Address - Street 1:160 E VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5857
Practice Address - Country:US
Practice Address - Phone:408-835-4464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT119968106H00000X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist