Provider Demographics
NPI:1336638527
Name:LOPEZ, LIZA M (BS)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3365 REEDY GLEN DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-2897
Mailing Address - Country:US
Mailing Address - Phone:321-514-9534
Mailing Address - Fax:
Practice Address - Street 1:131 WEBB DR STE C
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-3921
Practice Address - Country:US
Practice Address - Phone:863-438-6806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health