Provider Demographics
NPI:1528428240
Name:BRENDA KARINA LOPEZ LLC
Entity type:Organization
Organization Name:BRENDA KARINA LOPEZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:KARINA
Authorized Official - Last Name:LOPEZ LLC
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-217-1029
Mailing Address - Street 1:PO BOX 2766
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33539-2766
Mailing Address - Country:US
Mailing Address - Phone:813-217-1029
Mailing Address - Fax:
Practice Address - Street 1:38040 DAUGHTERY RD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540-1375
Practice Address - Country:US
Practice Address - Phone:813-713-6499
Practice Address - Fax:877-544-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW11658101Y00000X, 101YM0800X, 104100000X, 1041C0700X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty