Provider Demographics
NPI:1922619212
Name:LOPEZ, YOANNY
Entity Type:Individual
Prefix:
First Name:YOANNY
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5832
Mailing Address - Country:US
Mailing Address - Phone:561-236-4206
Mailing Address - Fax:
Practice Address - Street 1:1521 FOREST HILL BLVD STE 3B
Practice Address - Street 2:
Practice Address - City:LAKE CLARKE SHORES
Practice Address - State:FL
Practice Address - Zip Code:33406-6031
Practice Address - Country:US
Practice Address - Phone:561-506-3665
Practice Address - Fax:561-444-2458
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician