Healthcare Provider Details

I. General information

NPI: 1558987529
Provider Name (Legal Business Name): MARLENE N MORA-LOPEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19005 WILEYS WELL RD
BLYTHE CA
92225-2287
US

IV. Provider business mailing address

55275 RUE MONTIGNY
THERMAL CA
92274-9599
US

V. Phone/Fax

Practice location:
  • Phone: 760-921-3000
  • Fax:
Mailing address:
  • Phone: 760-238-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: