Healthcare Provider Details

I. General information

NPI: 1063964484
Provider Name (Legal Business Name): DNA COMPREHENSIVE THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6360 TECHSTER BLVD SUITE 1
FORT MYERS FL
33966-4805
US

IV. Provider business mailing address

4310 METRO PKWY STE 205
FORT MYERS FL
33916-9416
US

V. Phone/Fax

Practice location:
  • Phone: 239-223-2751
  • Fax: 239-561-2933
Mailing address:
  • Phone: 239-223-2751
  • Fax: 239-561-2933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELIZABETH N DOSORETZ
Title or Position: CEO
Credential: LCSW
Phone: 239-236-8784