Provider Demographics
NPI:1649984519
Name:CASTILLO LORENTE, YANET T
Entity type:Individual
Prefix:
First Name:YANET
Middle Name:T
Last Name:CASTILLO LORENTE
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 1:1301 W HOLLYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-3939
Mailing Address - Country:US
Mailing Address - Phone:813-570-4854
Mailing Address - Fax:
Practice Address - Street 1:1301 W HOLLYWOOD ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-3939
Practice Address - Country:US
Practice Address - Phone:813-570-4854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-244027106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician