| Elite Dna Therapy Services, Llc | |
|
6360 Techster Blvd Suite 1 Fort Myers FL 33966-4805 | |
| (239) 223-2751 | |
| (239) 561-2933 |
| Full Name | Elite Dna Therapy Services, Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 6360 Techster Blvd, Fort Myers, 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: (239) 223-2751 | Elite Dna Therapy Services, Llc 6360 Techster Blvd Suite 1 Fort Myers FL 33966-4805 Ph: (239) 223-2751 |
| NPI Number | 1063964484 |
|---|---|
| Provider Enumeration Date | 11/02/2016 |
| Last Update Date | 08/10/2020 |
| Certification Date | 08/10/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063964484 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
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