Healthcare Provider Details

I. General information

NPI: 1922483163
Provider Name (Legal Business Name): JESSICA PEDRE-LOPEZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 W 68TH ST
HIALEAH FL
33014-4435
US

IV. Provider business mailing address

1622 W 68TH ST
HIALEAH FL
33014-4435
US

V. Phone/Fax

Practice location:
  • Phone: 786-344-6118
  • Fax:
Mailing address:
  • Phone: 305-812-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27225
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: