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General NPI Number Information
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NPI Number | 1710835624
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Entity Type | Individual
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Provider Name | KIMBERLY LOPEZ CCMA
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Gender | Female
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Dates
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Enumeration Date | 03/17/2026
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Last Update Date | 03/17/2026
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Provider Practice Location Address
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Address Line | 445 E DUBLIN GRANVILLE RD BLDG G
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City | WORTHINGTON
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State | OH
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Zip | 43085
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Country | US
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Telephone | 800-409-2729
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Fax |
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Provider Business Mailing Address
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Address Line | 3369 TAMARACK AVE
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City | SPRINGFIELD
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State | OH
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Zip | 45502-7450
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Country | US
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Telephone | 800-409-2729
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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