Provider Demographics
NPI:1356957328
Name:LOPEZ, FRANCIS (BCBA)
Entity type:Individual
Prefix:
First Name:FRANCIS
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 DELIGHTFUL DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-7226
Mailing Address - Country:US
Mailing Address - Phone:786-955-7838
Mailing Address - Fax:
Practice Address - Street 1:14127 SW 51ST LN
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-5976
Practice Address - Country:US
Practice Address - Phone:786-955-7838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
FL1-20-44195103K00000X
FLMH22566101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44195Medicaid