Basic Information
| Provider Information | |||||||||
| NPI: | 1669592432 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOOTHBY-LLORENTE | ||||||||
| FirstName: | LOUISE | ||||||||
| MiddleName: | HELEN | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9909 VENETIAN RIVER WAY | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336195013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133260666 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 500 7TH AVE S | ||||||||
| Address2: | DEPARTMENT 7470 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337014820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277674403 | ||||||||
| FaxNumber: | 7277674715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | X | Behavioral Health & Social Service Providers | Psychologist | 104100000X | X | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.