Provider Demographics
NPI:1669197323
Name:LOPEZ, ARLENE (PSYD)
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2391 NW 96TH TER APT 19C
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3045
Mailing Address - Country:US
Mailing Address - Phone:954-482-2113
Mailing Address - Fax:305-517-5377
Practice Address - Street 1:800 SE 4TH AVE STE 816B
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-6498
Practice Address - Country:US
Practice Address - Phone:305-697-8997
Practice Address - Fax:305-517-5377
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11038103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist