Provider Demographics
NPI:1184259509
Name:LOPEZ ECHAZABAL, MAITE
Entity type:Individual
Prefix:
First Name:MAITE
Middle Name:
Last Name:LOPEZ ECHAZABAL
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 1:1326 SE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1751
Mailing Address - Country:US
Mailing Address - Phone:786-804-8416
Mailing Address - Fax:
Practice Address - Street 1:1326 SE 1ST ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-1751
Practice Address - Country:US
Practice Address - Phone:786-804-8416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0102629104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker