Provider Demographics
NPI:1245098870
Name:CENTENO-QUINTANA, LORRAINE (PHD, MSP)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:CENTENO-QUINTANA
Suffix:
Gender:F
Credentials:PHD, MSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10128 DEAN CHASE BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-4852
Mailing Address - Country:US
Mailing Address - Phone:907-201-0818
Mailing Address - Fax:
Practice Address - Street 1:5201 RAYMOND ST # C134
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-8208
Practice Address - Country:US
Practice Address - Phone:407-646-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-08
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist