Healthcare Provider Details

I. General information

NPI: 1356892269
Provider Name (Legal Business Name): DANETTE BEITRA PH.D., ABPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6535 NEMOURS PKWY
ORLANDO FL
32827-7884
US

IV. Provider business mailing address

6535 NEMOURS PKWY
ORLANDO FL
32827-7884
US

V. Phone/Fax

Practice location:
  • Phone: 407-650-7715
  • Fax:
Mailing address:
  • Phone: 407-650-7715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY 9626
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number37281
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: