Provider Demographics
NPI:1285413732
Name:LOPEZ, CHANEL DE LA CARIDAD (RBT)
Entity type:Individual
Prefix:
First Name:CHANEL
Middle Name:DE LA CARIDAD
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 W 75TH ST APT L
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4034
Mailing Address - Country:US
Mailing Address - Phone:786-237-7161
Mailing Address - Fax:
Practice Address - Street 1:885 W 75TH ST APT L
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4034
Practice Address - Country:US
Practice Address - Phone:786-237-7161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-274427106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician