Provider Demographics
NPI:1508971037
Name:LOPEZ, MABEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MABEL
Middle Name:
Last Name:LOPEZ
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 1:10175 6 MILE CYPRESS PKWY STE 3
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-6993
Mailing Address - Country:US
Mailing Address - Phone:239-768-6500
Mailing Address - Fax:239-768-6421
Practice Address - Street 1:10175 6 MILE CYPRESS PKWY STE 3
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-6993
Practice Address - Country:US
Practice Address - Phone:239-768-6500
Practice Address - Fax:239-768-6421
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7375103T00000X, 103TA0700X, 103TB0200X, 103TC0700X, 103TF0000X, 103TF0200X, 103TM1800X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY7375OtherFLORIDA LICENSE NUMBER