Provider Demographics
NPI:1558858241
Name:LOPEZ MANZANEDO, KATIA (RBT)
Entity Type:Individual
Prefix:
First Name:KATIA
Middle Name:
Last Name:LOPEZ MANZANEDO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9862 NW 82ND AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2535
Mailing Address - Country:US
Mailing Address - Phone:786-657-0005
Mailing Address - Fax:
Practice Address - Street 1:9862 NW 82ND AVE APT 107
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-2535
Practice Address - Country:US
Practice Address - Phone:786-657-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty