Provider Demographics
NPI:1881114155
Name:CASANOVA LOPEZ, ABEL (RBT)
Entity type:Individual
Prefix:
First Name:ABEL
Middle Name:
Last Name:CASANOVA LOPEZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 W 33RD ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5224
Mailing Address - Country:US
Mailing Address - Phone:786-542-3747
Mailing Address - Fax:
Practice Address - Street 1:1275 W 47TH PL STE 407
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3451
Practice Address - Country:US
Practice Address - Phone:786-541-3747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty