MEDICARE: CARLA BRINKERHOFF LOPEZ LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	8045	FL
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	8045	FL
3	101YP2500X	Professional Counselor	8045	FL
4	101YM0800X	Mental Health Counselor	8045	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033553672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA BRINKERHOFF LOPEZ LMHC

Provider Business Mailing Address
First Line	:	1527 NE 4TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-1035
Country	:	US
Telephone Number	:	954-835-5741
Fax Number	:	954-835-5746

Provider Business Practice Location Address
First Line	:	3600 N OCEAN BLVD FL 2
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-6424
Country	:	US
Telephone Number	:	954-835-5741
Fax Number	:	954-835-5746

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2013
Last Update Date	:	04/29/2025

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