Provider Demographics
NPI:1134466154
Name:VALDENEGRO LOPEZ, VANESSA R (BCBA)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:R
Last Name:VALDENEGRO LOPEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 STEWART ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-2437
Mailing Address - Country:US
Mailing Address - Phone:678-890-1055
Mailing Address - Fax:
Practice Address - Street 1:204 STEWART ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-2437
Practice Address - Country:US
Practice Address - Phone:678-890-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-15-20912103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1-15-20912OtherAPPLIED BEHAVIOR ANALYSIS (ABA)