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
1	1041C0700X	Clinical Social Worker	28059	CA

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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