Healthcare Provider Details

I. General information

NPI: 1124510060
Provider Name (Legal Business Name): MISS DANA GRESOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 OUTER RD
ORLANDO FL
32814-6601
US

IV. Provider business mailing address

8562 BOWDEN WAY
WINDERMERE FL
34786-5308
US

V. Phone/Fax

Practice location:
  • Phone: 407-217-1401
  • Fax:
Mailing address:
  • Phone: 734-731-6221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-305008
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-81323
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: