Provider Demographics
NPI:1689123366
Name:LOPEZ, YAZMIN (MSWA)
Entity Type:Individual
Prefix:
First Name:YAZMIN
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5262
Mailing Address - Country:US
Mailing Address - Phone:407-343-6006
Mailing Address - Fax:407-343-8289
Practice Address - Street 1:618 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5262
Practice Address - Country:US
Practice Address - Phone:407-343-6006
Practice Address - Fax:407-343-8289
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker