Provider Demographics
NPI:1255994372
Name:LOPEZ, STEPHANIE VALENTINA (MA)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:VALENTINA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:VALENTINA
Other - Last Name:LORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14499 N DALE MABRY HWY STE 130S
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2071
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14499 N DALE MABRY HWY STE 130S
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2071
Practice Address - Country:US
Practice Address - Phone:833-769-3524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
171M00000X
FLIMH23317101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator