Healthcare Provider Details

I. General information

NPI: 1720343668
Provider Name (Legal Business Name): CLARILLETTE HEREDIA M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16350 BRUCE B. DOWNS BLVD #48283
TAMPA FL
33647-9999
US

IV. Provider business mailing address

16350 BRUCE B. DOWNS BLVD #48283
TAMPA FL
33647-9999
US

V. Phone/Fax

Practice location:
  • Phone: 813-943-8111
  • Fax:
Mailing address:
  • Phone: 813-943-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT157797
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT2986
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: