Healthcare Provider Details

I. General information

NPI: 1043823669
Provider Name (Legal Business Name): MELISSA LOPES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12908 HAWKSTONE TRAIL BLVD
LITHIA FL
33547-5114
US

IV. Provider business mailing address

12908 HAWKSTONE TRAIL BLVD
LITHIA FL
33547-5114
US

V. Phone/Fax

Practice location:
  • Phone: 877-284-7074
  • Fax:
Mailing address:
  • Phone: 877-284-7074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW26516
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: