Provider Demographics
NPI:1770325235
Name:LOPEZ IGLESIAS, ANNALIE L (RBT)
Entity type:Individual
Prefix:
First Name:ANNALIE
Middle Name:L
Last Name:LOPEZ IGLESIAS
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4190 TURNBERRY CIR APT 1304
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-4033
Mailing Address - Country:US
Mailing Address - Phone:561-802-8050
Mailing Address - Fax:
Practice Address - Street 1:2500 N MILITARY TRL STE 304
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6324
Practice Address - Country:US
Practice Address - Phone:561-421-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician