Provider Demographics
NPI:1700053311
Name:REPETTO, LOREDANA
Entity Type:Individual
Prefix:
First Name:LOREDANA
Middle Name:
Last Name:REPETTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2329 SUNSET POINT ROAD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765
Mailing Address - Country:US
Mailing Address - Phone:727-669-3911
Mailing Address - Fax:727-669-3813
Practice Address - Street 1:2329 SUNSET POINT ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765
Practice Address - Country:US
Practice Address - Phone:727-669-3911
Practice Address - Fax:727-669-3813
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW82311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical