MEDICARE: DNA COMPREHENSIVE THERAPY SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1174375497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DNA COMPREHENSIVE THERAPY SERVICES, LLC

Provider Business Mailing Address
First Line	:	4310 METRO PKWY STE 205
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33916-9416
Country	:	US
Telephone Number	:	239-690-6906
Fax Number	:

Provider Business Practice Location Address
First Line	:	418 SW 47TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-6506
Country	:	US
Telephone Number	:	833-362-7935
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	ELIZABETH NOEMI DOSORETZ
Credential	:
Telephone Number	:	239-223-2751

Provider Enumeration Date	:	04/02/2024
Last Update Date	:	06/05/2025

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