Healthcare Provider Details

I. General information

NPI: 1043697402
Provider Name (Legal Business Name): ADAMAR DE JESUS CONCEPCION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1944 GARWOOD DR
ORLANDO FL
32822-6102
US

IV. Provider business mailing address

1944 GARWOOD DR
ORLANDO FL
32822-6102
US

V. Phone/Fax

Practice location:
  • Phone: 407-325-8459
  • Fax:
Mailing address:
  • Phone: 407-325-8459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-189645
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4097
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: