Active NPI
Laryssa Charisse Lopez, RBT
- Behavior Technician
- Melbourne, FL
National Provider Identifier
1053967893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-19-95786
- Practice address
- 125 E Nasa Blvd
Melbourne, FL 32901-1900 - Phone
- (321) 372-6813
- Fax
- (321) 765-6434
- NPI assigned
- Aug 16, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-19-95786 | FL | Primary |
Addresses
Primary practice location
125 E Nasa Blvd
Melbourne, FL 32901-1900
Mailing address
125 E Nasa Blvd
Melbourne, FL 32901-1900
Phone (321) 372-6813
Other practice location 1
2180 Julian Ave NW
Palm Bay, FL 32907
Phone (321) 372-6813
Other practice location 2
5830 US Highway 1
Rockledge, FL 32955-5704
Phone (321) 609-9007
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-19-95786 | FL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565913600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1576713600000",
"number": "1053967893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 E NASA BLVD",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329011900",
"telephone_number": "321-372-6813",
"fax_number": "321-765-6434"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 E NASA BLVD",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329011900",
"telephone_number": "321-372-6813",
"fax_number": "321-765-6434"
}
],
"practiceLocations": [
{
"address_1": "2180 Julian Ave NW",
"address_purpose": "LOCATION",
"city": "Palm Bay",
"state": "FL",
"postal_code": "32907",
"country_code": "US",
"telephone_number": "321-372-6813",
"fax_number": "321-765-6434",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "5830 US Highway 1",
"address_purpose": "LOCATION",
"city": "Rockledge",
"state": "FL",
"postal_code": "329555704",
"country_code": "US",
"telephone_number": "321-609-9007",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LOPEZ",
"first_name": "LARYSSA",
"middle_name": "CHARISSE",
"credential": "RBT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-08-16",
"last_updated": "2019-12-19",
"certification_date": "2019-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "RBT-19-95786",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.