Healthcare Provider Details

I. General information

NPI: 1063391654
Provider Name (Legal Business Name): FOUNDATIONS BEHAVIORAL THERAPY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 DEL PRADO BLVD N STE F
CAPE CORAL FL
33909-6303
US

IV. Provider business mailing address

19 DEL PRADO BLVD N STE F
CAPE CORAL FL
33909-6303
US

V. Phone/Fax

Practice location:
  • Phone: 786-663-6956
  • Fax:
Mailing address:
  • Phone: 786-663-6956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MELANIE CALZADILLA
Title or Position: OFFICER
Credential:
Phone: 786-663-6956