MEDICARE: CHELSEA L'ETOILE-LOPES BCBA

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	103K00000X	Behavior Analyst	1-19-35056	FL

General Provider Information

NPI Number	:	1679069348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA L'ETOILE-LOPES BCBA

Provider Business Mailing Address
First Line	:	10006 PALERMO CIR APT 104
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-5036
Country	:	US
Telephone Number	:	402-215-6660
Fax Number	:

Provider Business Practice Location Address
First Line	:	10006 PALERMO CIR APT 104
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-5036
Country	:	US
Telephone Number	:	402-215-6660
Fax Number	:

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

Provider Enumeration Date	:	07/06/2018
Last Update Date	:	07/18/2019

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