Provider Demographics
NPI:1447682836
Name:LOPEZ ASAAH, VANESSA E (LCSW)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:E
Last Name:LOPEZ ASAAH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:E
Other - Last Name:LOPEZ-ASAAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACSW
Mailing Address - Street 1:2992 ESSIE PL
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-8727
Mailing Address - Country:US
Mailing Address - Phone:209-408-6172
Mailing Address - Fax:
Practice Address - Street 1:917 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4593
Practice Address - Country:US
Practice Address - Phone:209-558-7400
Practice Address - Fax:209-558-8315
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1090571041C0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program