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NPI Code Detail

MEDICARE: DNA COMPREHENSIVE THERAPY SERVICES, LLC

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
1101Y00000XCounselor
2103K00000XBehavior Analyst
3103TC0700XClinical Psychologist
4104100000XSocial Worker
52084P0800XPsychiatry Physician
6261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1194566877
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 : 2252 KILLEARN CENTER BLVD STE 300
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32309-3573
Country : US
Telephone Number : 833-362-7935
Fax Number :
Authorized Official
Title or Position : CEO
Name : ELIZABETH NOEMI DOSORETZ
Credential :
Telephone Number : 239-223-2751
Provider Enumeration Date : 06/05/2024
Last Update Date : 06/05/2025

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