MEDICARE: DR. CAROLINA HENAO IRURITA PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst
2	103TC0700X	Clinical Psychologist	PY11697	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1518315373	OTHER	FL	LICENSED PSYCHOLOGIST

General Provider Information

NPI Number	:	1518315373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLINA HENAO IRURITA PH.D.

Provider Business Mailing Address
First Line	:	12425 MARLEIGH CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-8650
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3680 AVALON PARK EAST BLVD STE 203
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-9373
Country	:	US
Telephone Number	:	321-340-3038
Fax Number	:	407-604-6671

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2016
Last Update Date	:	04/23/2025

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