Provider Demographics
NPI:1992244248
Name:LOPEZ, MICHELLE ROXANA (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ROXANA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 W PRAIRIE CIR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-3740
Mailing Address - Country:US
Mailing Address - Phone:407-720-9789
Mailing Address - Fax:386-368-7458
Practice Address - Street 1:2051 W PRAIRIE CIR
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-3740
Practice Address - Country:US
Practice Address - Phone:407-720-9789
Practice Address - Fax:386-368-7458
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW166461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCSW.09928469OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES
FLSW16646OtherFLORIDA DEPARTMENT OF HEALTH