MEDICARE: LILIANA PATRICIA LOPEZ MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH17825	FL
2	103K00000X	Behavior Analyst		FL

General Provider Information

NPI Number	:	1356698427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILIANA PATRICIA LOPEZ MS

Provider Business Mailing Address
First Line	:	14195 SW 87TH ST # B110
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-4083
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14195 SW 87TH ST APT 110
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-4419
Country	:	US
Telephone Number	:	786-416-3102
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2012
Last Update Date	:	04/07/2022

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