Provider Demographics
NPI:1821891979
Name:LOPEZ, YESENNIA (LCSW)
Entity type:Individual
Prefix:
First Name:YESENNIA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MAGNOLIA AVE STE 2195
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-2910
Mailing Address - Country:US
Mailing Address - Phone:714-325-3091
Mailing Address - Fax:
Practice Address - Street 1:275 MAGNOLIA AVE STE 2195
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-2910
Practice Address - Country:US
Practice Address - Phone:714-325-3091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1293111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty