Provider Demographics
NPI:1386282648
Name:LOPEZ LEYVA, JOEL (RBT)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:LOPEZ LEYVA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 SW 1ST TER
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-3442
Mailing Address - Country:US
Mailing Address - Phone:786-818-7342
Mailing Address - Fax:
Practice Address - Street 1:291 SW 1ST TER
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-3442
Practice Address - Country:US
Practice Address - Phone:786-818-7342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-108524106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty