Provider Demographics
NPI:1396226577
Name:LOPEZ- TORO, EDITH (PHD)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:LOPEZ- TORO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COOPERATIVA JARDINES DE SAN IGNACIO
Mailing Address - Street 2:1503A
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927
Mailing Address - Country:US
Mailing Address - Phone:787-439-5886
Mailing Address - Fax:
Practice Address - Street 1:406 NW 93RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2138
Practice Address - Country:US
Practice Address - Phone:787-439-5886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst