Healthcare Provider Details

I. General information

NPI: 1720019557
Provider Name (Legal Business Name): AMERICAN THERAPEUTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4790 N ORANGE BLOSSOM TRL
ORLANDO FL
32810-1601
US

IV. Provider business mailing address

1801 NE 2ND AVE
MIAMI FL
33132-1000
US

V. Phone/Fax

Practice location:
  • Phone: 407-298-0461
  • Fax: 407-298-8016
Mailing address:
  • Phone: 305-371-5777
  • Fax: 305-371-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberHCC3296
License Number StateFL

VIII. Authorized Official

Name: MS. MARIANELLA VALERA
Title or Position: PRESIDENT AND CEO
Credential: LMHC
Phone: 305-371-5777