Healthcare Provider Details

I. General information

NPI: 1073459897
Provider Name (Legal Business Name): REALIZE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 BISCAYNE BLVD STE 1440
MIAMI FL
33137-3247
US

IV. Provider business mailing address

5700 COLLINS AVE APT 15K
MIAMI BEACH FL
33140-2315
US

V. Phone/Fax

Practice location:
  • Phone: 786-657-8054
  • Fax:
Mailing address:
  • Phone: 786-657-8054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARIA A LOPEZ SR.
Title or Position: OWNER / CLINICAL DIRECTOR
Credential: LMHC
Phone: 786-657-8054