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General NPI Number Information
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NPI Number | 1124510060
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Entity Type | Individual
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Provider Name | MISS DANA GRESOCK
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Gender | Female
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 907 OUTER RD
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City | ORLANDO
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State | FL
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Zip | 32814-6601
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Country | US
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Telephone | 407-217-1401
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Fax |
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Provider Business Mailing Address
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Address Line | 8562 BOWDEN WAY
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City | WINDERMERE
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State | FL
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Zip | 34786-5308
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Country | US
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Telephone | 734-731-6221
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-23-305008
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-25-81323
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License Number State | FL
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