Provider Demographics
NPI:1558641993
Name:LOPEZ, MELISSA (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4504
Mailing Address - Country:US
Mailing Address - Phone:407-218-4340
Mailing Address - Fax:407-218-4303
Practice Address - Street 1:500 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4504
Practice Address - Country:US
Practice Address - Phone:407-218-4340
Practice Address - Fax:407-218-4303
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-11-8909103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019528700Medicaid