Individual
ELIZABETH LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
4161 TAMIAMI TRL STE 401, PORT CHARLOTTE, FL 33952-9254
(941) 235-2710
Mailing address
1306 SW 6TH TER, CAPE CORAL, FL 33991-2153
(786) 413-8067
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY11246
FL
Other
Enumeration date
10/15/2021
Last updated
10/15/2021
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