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NPI Code Detail

MEDICARE: MRS. MARY JANETT LOPEZ-INAYAMA LCSW

MEDICARE: MRS. MARY JANETT LOPEZ-INAYAMA LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker28059CA

General Provider Information

NPI Number : 1699110148
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY JANETT LOPEZ-INAYAMA LCSW
Provider Business Mailing Address
First Line : 145 HODENCAMP RD STE 201
Second Line :
City : THOUSAND OAKS
State : CA
Zip : 91360-5817
Country : US
Telephone Number : 805-509-6590
Fax Number :
Provider Business Practice Location Address
First Line : 2440 AVENIDA DE LAS PLANTAS
Second Line :
City : THOUSAND OAKS
State : CA
Zip : 91360-6618
Country : US
Telephone Number : 805-509-6590
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2013
Last Update Date : 12/06/2021

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