Provider Demographics
NPI:1760211247
Name:LOPEZ, LAURA G (RBT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:G
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13814 RUSHING CREEK RUN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-9225
Mailing Address - Country:US
Mailing Address - Phone:917-818-5058
Mailing Address - Fax:407-960-3009
Practice Address - Street 1:13814 RUSHING CREEK RUN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-9225
Practice Address - Country:US
Practice Address - Phone:917-818-5058
Practice Address - Fax:407-960-3009
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-363776106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician