Provider Demographics
NPI:1649938903
Name:LOPEZ, LUZ MARINA (LMHC)
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:MARINA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 NE 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-6460
Mailing Address - Country:US
Mailing Address - Phone:954-257-1008
Mailing Address - Fax:
Practice Address - Street 1:138 NE 1ST ST # A-204
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6604
Practice Address - Country:US
Practice Address - Phone:954-205-6546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19892101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health