Healthcare Provider Details

I. General information

NPI: 1033653779
Provider Name (Legal Business Name): AKESO BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2016
Last Update Date: 11/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 LAKE ELLENOR DR #212
ORLANDO FL
32809-4614
US

IV. Provider business mailing address

6100 LAKE ELLENOR DR STE 212
ORLANDO FL
32809-4632
US

V. Phone/Fax

Practice location:
  • Phone: 407-325-2235
  • Fax:
Mailing address:
  • Phone: 407-325-2235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIANA CARROZZA
Title or Position: OWNER
Credential: MA
Phone: 407-325-2235