Provider Demographics
NPI:1518315373
Name:IRURITA, CAROLINA HENAO (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINA
Middle Name:HENAO
Last Name:IRURITA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CAROLINA
Other - Middle Name:
Other - Last Name:HENAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12425 MARLEIGH CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-8650
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12425 MARLEIGH CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-8650
Practice Address - Country:US
Practice Address - Phone:321-287-0325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FLPY11697103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1518315373OtherLICENSED PSYCHOLOGIST