Healthcare Provider Details

I. General information

NPI: 1558520148
Provider Name (Legal Business Name): FLORIDA INSTITUTE OF TECHNOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W UNIVERSITY BLVD THE SCOTT CENTER FOR AUTISM TREATMENT
MELBOURNE FL
32901
US

IV. Provider business mailing address

150 W UNIVERSITY BLVD THE SCOTT CENTER FOR AUTISM TREATMENT
MELBOURNE FL
32901-6975
US

V. Phone/Fax

Practice location:
  • Phone: 321-674-8106
  • Fax: 321-674-8411
Mailing address:
  • Phone: 321-674-8106
  • Fax: 321-674-8411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: ASHLEY ADAMS
Title or Position: CLINICAL OPERATIONS ASSOCIATE
Credential:
Phone: 321-674-8106