Provider Demographics
NPI:1447923586
Name:MACHADO LOPEZ, DEBORAH (CBHCM-P)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:MACHADO LOPEZ
Suffix:
Gender:F
Credentials:CBHCM-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11085 SW 221ST TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-3040
Mailing Address - Country:US
Mailing Address - Phone:786-348-3506
Mailing Address - Fax:
Practice Address - Street 1:11085 SW 221ST TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170-3040
Practice Address - Country:US
Practice Address - Phone:786-348-3506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMP100814104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker