Provider Demographics
NPI:1366214942
Name:LOPEZ, ANABELLYS SALCEDO
Entity type:Individual
Prefix:
First Name:ANABELLYS
Middle Name:SALCEDO
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38032 POSTAL DR UNIT 2641
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33539-7107
Mailing Address - Country:US
Mailing Address - Phone:813-438-2212
Mailing Address - Fax:
Practice Address - Street 1:520 E GARDEN ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4616
Practice Address - Country:US
Practice Address - Phone:813-438-2212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH24807101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health