Provider Demographics
NPI:1134775232
Name:LOPEZ, NANCY LETICIA
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:LETICIA
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 1:1655 PALM BEACH LAKES BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2208
Mailing Address - Country:US
Mailing Address - Phone:561-422-9571
Mailing Address - Fax:561-881-0972
Practice Address - Street 1:1655 PALM BEACH LAKES BLVD STE 600
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2208
Practice Address - Country:US
Practice Address - Phone:561-422-9571
Practice Address - Fax:561-881-0972
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker