Provider Demographics
NPI:1699121855
Name:LOPEZ, LIZETTE MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:LIZETTE
Middle Name:MARIE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10631 N KENDALL DR STE 155
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1559
Mailing Address - Country:US
Mailing Address - Phone:786-735-2011
Mailing Address - Fax:
Practice Address - Street 1:10631 N KENDALL DR STE 155
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1559
Practice Address - Country:US
Practice Address - Phone:786-735-2011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP 5267101YA0400X
FLMT2816106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)