Organization
MIND AND BRAIN CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MABEL LOPEZ PHD (OWNER)
(239) 768-6500
Entity
Organization
Contact information
Practice address
10175 6 MILE CYPRESS PKWY STE 3, FORT MYERS, FL 33966-6993
(239) 768-6500
Mailing address
10175 6 MILE CYPRESS PKWY, SUITE 3, FORT MYERS, FL 33966-9663
(239) 768-6500
(239) 768-6421
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PY7375
FL
103TB0200X
Cognitive & Behavioral Psychologist
PY7375
FL
103TC0700X
Clinical Psychologist
PY7375
FL
103TC1900X
Counseling Psychologist
PY7375
FL
103TC2200X
Clinical Child & Adolescent Psychologist
PY7375
FL
103TF0200X
Forensic Psychologist
PY7375
FL
103TM1800X
Intellectual & Developmental Disabilities Psychologist
PY7375
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6022640
CIGNA
FL
01
—
75725
BCBS
FL
Enumeration date
08/30/2010
Last updated
12/11/2023
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