Healthcare Provider Details

I. General information

NPI: 1770018483
Provider Name (Legal Business Name): FLORIDA CENTER FOR ATTACHMENT & TRAUMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CONSTITUTION BLVD STE 115
SARASOTA FL
34231-4146
US

IV. Provider business mailing address

2001 RIVER PARK CT
VALRICO FL
33596-7233
US

V. Phone/Fax

Practice location:
  • Phone: 813-712-9975
  • Fax:
Mailing address:
  • Phone: 813-712-9975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TERESA D BARTLETT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MPH, CWCM
Phone: 813-712-9975