Elite Dna Therapy Services, Llc | |
19531 Cochran Blvd Port Charlotte FL 33948-2081 | |
(239) 223-2751 | |
(239) 561-2933 |
Full Name | Elite Dna Therapy Services, Llc |
---|---|
Speciality | Psychologist - Clinical |
Location | 19531 Cochran Blvd, Port Charlotte, Florida |
Authorized Official Name and Position | Elizabeth N. Dosoretz (CEO) |
Authorized Official Contact | 2392368784 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Elite Dna Therapy Services, Llc 4310 Metro Pkwy Ste 205 Fort Myers FL 33916-9416 Ph: (833) 362-7935 | Elite Dna Therapy Services, Llc 19531 Cochran Blvd Port Charlotte FL 33948-2081 Ph: (239) 223-2751 |
NPI Number | 1003351966 |
---|---|
Provider Enumeration Date | 01/03/2017 |
Last Update Date | 06/02/2023 |
Certification Date | 06/02/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1003351966 | NPI | - | NPPES |
014482100 | Medicaid | FL | |
010785500 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
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