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General NPI Number Information
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NPI Number | 1770033748
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Entity Type | Organization
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Legal Business Name | FLORIDA CHILDREN'S INSTITUTE
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Dates
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Enumeration Date | 10/13/2016
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Last Update Date | 10/13/2016
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Provider Practice Location Address
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Address Line | 8777 SAN JOSE BLVD SUITE 801
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City | JACKSONVILLE
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State | FL
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Zip | 32217-4213
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Country | US
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Telephone | 904-374-6403
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Fax |
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Provider Business Mailing Address
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Address Line | 8777 SAN JOSE BLVD SUITE 801
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City | JACKSONVILLE
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State | FL
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Zip | 32217-4213
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Country | US
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Telephone | 904-374-6403
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Fax |
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Authorized Official
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Title or Position | CEO AND OWNER
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Name | DR. CATHERINE BAKER SIMMS
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Credential | PHD, BCBA-D
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Telephone | 904-374-6403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | RBT-16-22849
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License Number State | FL
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