Provider Demographics
NPI:1326838988
Name:ESTENOZ LOPEZ, BETTY
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:ESTENOZ LOPEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9913 CROFTON LN # IN
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-4210
Mailing Address - Country:US
Mailing Address - Phone:813-956-2157
Mailing Address - Fax:
Practice Address - Street 1:9913 CROFTON LN # IN
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-4210
Practice Address - Country:US
Practice Address - Phone:813-956-2157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-432851106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician