Healthcare Provider Details

I. General information

NPI: 1902057409
Provider Name (Legal Business Name): RAENA ROSHANA BAPTISTE-BOLES PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 N 12TH AVE BLDG B
ARCADIA FL
34266-8752
US

IV. Provider business mailing address

1817 CRESCENT BLVD SUITE 101-C
ORLANDO FL
32817-4619
US

V. Phone/Fax

Practice location:
  • Phone: 863-494-1242
  • Fax: 863-491-0466
Mailing address:
  • Phone: 407-494-4388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY8557
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: