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General NPI Number Information
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NPI Number | 1396523254
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Entity Type | Organization
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Legal Business Name | MINDSCOPE CLINIC LLC
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Dates
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Enumeration Date | 09/20/2023
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 3680 AVALON PARK EAST BLVD STE 203
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City | ORLANDO
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State | FL
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Zip | 32828-9372
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Country | US
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Telephone | 321-340-3038
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Fax | 407-604-6671
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Provider Business Mailing Address
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Address Line | 12425 MARLEIGH CT
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City | ORLANDO
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State | FL
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Zip | 32828-8650
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. CAROLINA HENAO IRURITA
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Credential | PH.D
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Telephone | 321-287-0325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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