| Mindscope Clinic Llc | |
|
3680 Avalon Park East Blvd Ste 203 Orlando FL 32828-9372 | |
| (321) 340-3038 | |
| (407) 604-6671 |
| Full Name | Mindscope Clinic Llc |
|---|---|
| Speciality | Psychologist |
| Location | 3680 Avalon Park East Blvd Ste 203, Orlando, Florida |
| Authorized Official Name and Position | Carolina Henao Irurita (LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 3212870325 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindscope Clinic Llc 12425 Marleigh Ct Orlando FL 32828-8650 Ph: () - | Mindscope Clinic Llc 3680 Avalon Park East Blvd Ste 203 Orlando FL 32828-9372 Ph: (321) 340-3038 |
| NPI Number | 1396523254 |
|---|---|
| Provider Enumeration Date | 09/20/2023 |
| Last Update Date | 12/13/2023 |
| Certification Date | 12/13/2023 |
| Medicare PECOS PAC ID | 3173979150 |
|---|---|
| Medicare Enrollment ID | O20231026004055 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396523254 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Secondary |
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Carolina Henao Irurita |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1518315373 PECOS PAC ID: 4082060066 Enrollment ID: I20231026004088 |
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