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General NPI Number Information
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NPI Number | 1558102582
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Entity Type | Individual
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Provider Name | LILLIANA LOPEZ PSYD
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Gender | Female
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 1340 CELEBRATION BLVD
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City | FLORENCE
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State | SC
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Zip | 29501-5585
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Country | US
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Telephone | 787-349-8395
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Fax |
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Provider Business Mailing Address
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Address Line | 1435 GOLF TERRACE BLVD APT 2
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City | FLORENCE
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State | SC
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Zip | 29501-0233
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Country | US
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Telephone | 843-536-1180
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 7562
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License Number State | PR
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