Provider Demographics
NPI:1881726842
Name:LOPEZ-URBINA, JEANETTE SUSAN (MSW)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:SUSAN
Last Name:LOPEZ-URBINA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:SUSAN
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:356 TENNENT AVE
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-1627
Mailing Address - Country:US
Mailing Address - Phone:562-714-6770
Mailing Address - Fax:
Practice Address - Street 1:1918 BONITA AVE FL 2
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704
Practice Address - Country:US
Practice Address - Phone:510-269-7718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA660901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health