MEDICARE: DNA COMPREHENSIVE THERAPY SERVICES, LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1396419610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DNA COMPREHENSIVE THERAPY SERVICES, LLC

Provider Business Mailing Address
First Line	:	4310 METRO PKWY STE 205
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33916-9416
Country	:	US
Telephone Number	:	239-236-8784
Fax Number	:	239-790-2624

Provider Business Practice Location Address
First Line	:	6801 PORTO FINO CIR STE 1
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4344
Country	:	US
Telephone Number	:	239-223-2751
Fax Number	:	239-561-2933

Authorized Official
Title or Position	:	CEO
Name	:	ELIZABETH NOEMI DOSORETZ
Credential	:	LCSW
Telephone Number	:	239-223-2751

Provider Enumeration Date	:	08/02/2021
Last Update Date	:	06/24/2025

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