Provider Demographics
NPI:1467103622
Name:SPEECH PATHOLOGY OF CORAL GABLES, INC.
Entity Type:Organization
Organization Name:SPEECH PATHOLOGY OF CORAL GABLES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOPES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:305-774-1788
Mailing Address - Street 1:603 SW 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-3919
Mailing Address - Country:US
Mailing Address - Phone:305-774-1788
Mailing Address - Fax:
Practice Address - Street 1:603 SW 57TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-3919
Practice Address - Country:US
Practice Address - Phone:305-774-1788
Practice Address - Fax:305-774-1789
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPEECH PATHOLOGY OF CORAL GABLES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023855600Medicaid