Healthcare Provider Details

I. General information

NPI: 1760345490
Provider Name (Legal Business Name): MLC BEHAVIOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 COLLEGE PKWY STE 107
FORT MYERS FL
33919-4111
US

IV. Provider business mailing address

8140 COLLEGE PKWY STE 107
FORT MYERS FL
33919-4111
US

V. Phone/Fax

Practice location:
  • Phone: 786-546-1092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MARY LAURA CASIDO
Title or Position: CEO
Credential:
Phone: 786-546-1092