Provider Demographics
NPI:1912452103
Name:LOPEZ, MARIA L (BCABA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 ARBOUR WALK CIR APT 223
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-6863
Mailing Address - Country:US
Mailing Address - Phone:239-465-2747
Mailing Address - Fax:772-675-9100
Practice Address - Street 1:8591 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34224-7695
Practice Address - Country:US
Practice Address - Phone:885-832-6727
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-20-10879106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst