Provider Demographics
NPI:1952433609
Name:LOPEZ, MARIBEL (MA)
Entity Type:Individual
Prefix:MS
First Name:MARIBEL
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 E HACKETT RD # N8T
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358-9415
Mailing Address - Country:US
Mailing Address - Phone:209-558-3647
Mailing Address - Fax:209-558-3962
Practice Address - Street 1:251 E HACKETT RD # N8T
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358-9415
Practice Address - Country:US
Practice Address - Phone:209-558-3647
Practice Address - Fax:209-558-3962
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49996106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist