Provider Demographics
NPI:1669592432
Name:BOOTHBY-LLORENTE, LOUISE HELEN (PHD)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:HELEN
Last Name:BOOTHBY-LLORENTE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9909 VENETIAN RIVER WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-5013
Mailing Address - Country:US
Mailing Address - Phone:813-326-0666
Mailing Address - Fax:
Practice Address - Street 1:500 7TH AVE S
Practice Address - Street 2:DEPARTMENT 7470
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4820
Practice Address - Country:US
Practice Address - Phone:727-767-4403
Practice Address - Fax:727-767-4715
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker