Healthcare Provider Details

I. General information

NPI: 1033585088
Provider Name (Legal Business Name): ALEXIS CARMEN LOPEZ MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date: 06/02/2016
Reactivation Date: 08/12/2016

III. Provider practice location address

1227 E LOS ANGELES AVE
SIMI VALLEY CA
93065-2871
US

IV. Provider business mailing address

1227 E LOS ANGELES AVE
SIMI VALLEY CA
93065-2871
US

V. Phone/Fax

Practice location:
  • Phone: 805-582-4080
  • Fax: 805-579-6010
Mailing address:
  • Phone: 805-582-4080
  • Fax: 805-579-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number99298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: