Provider Demographics
NPI:1215643648
Name:URDANETA, CLARYNES CARINA I (PHD)
Entity type:Individual
Prefix:DR
First Name:CLARYNES
Middle Name:CARINA
Last Name:URDANETA
Suffix:I
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CLARYNES
Other - Middle Name:CARINA
Other - Last Name:URDANETA
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2145 W SOCRUM LOOP RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-0346
Mailing Address - Country:US
Mailing Address - Phone:863-274-0540
Mailing Address - Fax:
Practice Address - Street 1:2145 W SOCRUM LOOP RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-0346
Practice Address - Country:US
Practice Address - Phone:863-274-0540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health