Basic Information
| Provider Information | |||||||||
| NPI: | 1972639391 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOPEZ | ||||||||
| FirstName: | NORMA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 EDWIN DR | ||||||||
| Address2: | |||||||||
| City: | KENSINGTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947071022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105459184 | ||||||||
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| Practice Location | |||||||||
| Address1: | 205 PACIFICA AVE | ||||||||
| Address2: | |||||||||
| City: | BAY POINT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945652904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256828000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 12/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | LCSW66591 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.