Provider Demographics
NPI:1104497353
Name:LOPEZ, DENNIS D (CBHCMS)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:D
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 DEL PRADO BLVD S STE 106
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-7219
Mailing Address - Country:US
Mailing Address - Phone:239-540-9555
Mailing Address - Fax:239-549-0875
Practice Address - Street 1:2804 DEL PRADO BLVD S STE 106
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7219
Practice Address - Country:US
Practice Address - Phone:239-540-9555
Practice Address - Fax:239-549-0875
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106616400Medicaid