Healthcare Provider Details

I. General information

NPI: 1356684054
Provider Name (Legal Business Name): PUTTING THE PIECES TOGETHER BEHAVIORAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 MARIPOSA CIR APT 102
NAPLES FL
34105-7259
US

IV. Provider business mailing address

1355 MARIPOSA CIR APT 102
NAPLES FL
34105-7259
US

V. Phone/Fax

Practice location:
  • Phone: 603-738-9369
  • Fax:
Mailing address:
  • Phone: 603-738-9369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1-12-10161
License Number StateFL

VIII. Authorized Official

Name: SARAH BETH BERTRAND-ZELAYA
Title or Position: OWNER/BEHAVIOR ANALYST
Credential: BCBA
Phone: 603-738-9369