Provider Demographics
NPI:1558858241
Name:LOPEZ MANZANEDO, KATIA (BCBA)
Entity type:Individual
Prefix:
First Name:KATIA
Middle Name:
Last Name:LOPEZ MANZANEDO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 W 35TH AVE UNIT 157
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-7122
Mailing Address - Country:US
Mailing Address - Phone:786-657-0005
Mailing Address - Fax:786-657-0005
Practice Address - Street 1:7001 W 35TH AVE UNIT 157
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-7122
Practice Address - Country:US
Practice Address - Phone:786-657-0005
Practice Address - Fax:786-657-0005
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X, 106S00000X
FL1-25-82126103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty