Provider Demographics
NPI:1174403471
Name:SPITZER, MIRTA LOPEZ (LCSW)
Entity type:Individual
Prefix:
First Name:MIRTA
Middle Name:LOPEZ
Last Name:SPITZER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 6TH STREET
Mailing Address - Street 2:PO BOX 346
Mailing Address - City:SAN JUAN BAUTISTA
Mailing Address - State:CA
Mailing Address - Zip Code:95045
Mailing Address - Country:US
Mailing Address - Phone:831-578-1559
Mailing Address - Fax:
Practice Address - Street 1:302 6TH STREET
Practice Address - Street 2:PO BOX 346
Practice Address - City:SAN JUAN BAUTISTA
Practice Address - State:CA
Practice Address - Zip Code:95045
Practice Address - Country:US
Practice Address - Phone:831-578-1559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1155441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical