Provider Demographics
NPI:1437838109
Name:LOPEZ GONZALEZ, ALISNEY
Entity Type:Individual
Prefix:
First Name:ALISNEY
Middle Name:
Last Name:LOPEZ GONZALEZ
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 1:25921 SW 132ND AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6963
Mailing Address - Country:US
Mailing Address - Phone:305-333-9943
Mailing Address - Fax:
Practice Address - Street 1:25921 SW 132ND AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-6963
Practice Address - Country:US
Practice Address - Phone:305-333-9943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-277085106E00000X
FL23277085106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst