| 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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