Provider Demographics
NPI:1861071771
Name:MACHADO LOPEZ, LIDYS
Entity type:Individual
Prefix:
First Name:LIDYS
Middle Name:
Last Name:MACHADO 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 1:622 EL PRADO APT 4
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-1977
Mailing Address - Country:US
Mailing Address - Phone:786-690-4159
Mailing Address - Fax:
Practice Address - Street 1:2151 45TH ST STE 304
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2011
Practice Address - Country:US
Practice Address - Phone:561-328-9344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-135272106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician