Provider Demographics
NPI:1942646070
Name:KARLA D PENA ROSA PHD LLC
Entity Type:Organization
Organization Name:KARLA D PENA ROSA PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:PENA ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:321-246-7490
Mailing Address - Street 1:412 S HART BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-1950
Mailing Address - Country:US
Mailing Address - Phone:321-246-7490
Mailing Address - Fax:
Practice Address - Street 1:412 S HART BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-1950
Practice Address - Country:US
Practice Address - Phone:321-246-7490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 8755103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty