Provider Demographics
NPI:1073268793
Name:LOPEZ, JANET
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 CAROLINE ST STE 206-1
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-6732
Mailing Address - Country:US
Mailing Address - Phone:786-475-5732
Mailing Address - Fax:844-455-3224
Practice Address - Street 1:955 CAROLINE ST STE 206-1
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-6732
Practice Address - Country:US
Practice Address - Phone:786-475-5732
Practice Address - Fax:844-455-3224
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-193424106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician