Provider Demographics
NPI:1821846296
Name:LOPEZ PUPO, ADRIANA (RBT)
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:LOPEZ PUPO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6858 MARILANE ST
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-6725
Mailing Address - Country:US
Mailing Address - Phone:689-680-4101
Mailing Address - Fax:
Practice Address - Street 1:6858 MARILANE ST
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-6725
Practice Address - Country:US
Practice Address - Phone:689-680-4101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-318705106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician