Provider Demographics
NPI:1134981517
Name:LOPEZ RIVERO, LILIAN ELENA
Entity type:Individual
Prefix:
First Name:LILIAN
Middle Name:ELENA
Last Name:LOPEZ RIVERO
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 1:2180 TARRAGON RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-7012
Mailing Address - Country:US
Mailing Address - Phone:561-294-4834
Mailing Address - Fax:
Practice Address - Street 1:2180 TARRAGON RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-7012
Practice Address - Country:US
Practice Address - Phone:561-294-4834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-304472106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician