Provider Demographics
NPI:1982816856
Name:DOLENTE, RALPH J (PSYD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:J
Last Name:DOLENTE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 GATEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-8832
Mailing Address - Country:US
Mailing Address - Phone:863-534-3017
Mailing Address - Fax:863-534-8008
Practice Address - Street 1:150 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-4742
Practice Address - Country:US
Practice Address - Phone:863-534-3017
Practice Address - Fax:863-534-8008
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4209103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist