Provider Demographics
NPI:1730580481
Name:BURNETT LOPEZ, FELICIA (LCSW)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:BURNETT LOPEZ
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 1:1118 BRUNSWICK WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-2034
Mailing Address - Country:US
Mailing Address - Phone:916-838-5215
Mailing Address - Fax:
Practice Address - Street 1:1118 BRUNSWICK WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-2034
Practice Address - Country:US
Practice Address - Phone:916-838-5215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA936611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical