Provider Demographics
NPI:1265047963
Name:LOPEZ, DAINERYS TERESA
Entity type:Individual
Prefix:
First Name:DAINERYS
Middle Name:TERESA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAINERYS
Other - Middle Name:TERESA
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2427 FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-4406
Mailing Address - Country:US
Mailing Address - Phone:561-294-1369
Mailing Address - Fax:561-584-5033
Practice Address - Street 1:2119 10TH AVE N
Practice Address - Street 2:
Practice Address - City:LAKE WORTH BEACH
Practice Address - State:FL
Practice Address - Zip Code:33461-3345
Practice Address - Country:US
Practice Address - Phone:561-506-3665
Practice Address - Fax:561-444-2458
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician