Provider Demographics
| NPI: | 1316363757 |
|---|---|
| Name: | DNA COMPREHENSIVE THERAPY SERVICES, LLC |
| Entity Type: | Organization |
| Organization Name: | DNA COMPREHENSIVE THERAPY SERVICES, LLC |
| Other - Org Name: | ELITE DNA THERAPY SERVICES |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | ELIZABETH |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | DOSORETZ |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | LCSW |
| Authorized Official - Phone: | 239-223-2751 |
| Mailing Address - Street 1: | 4310 METRO PKWY STE 205 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | FORT MYERS |
| Mailing Address - State: | FL |
| Mailing Address - Zip Code: | 33916-9416 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 239-223-2751 |
| Mailing Address - Fax: | 239-561-2933 |
| Practice Address - Street 1: | 4310 METRO PKWY STE 205 |
| Practice Address - Street 2: | |
| Practice Address - City: | FORT MYERS |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 33916-9416 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 239-223-2751 |
| Practice Address - Fax: | 239-561-2933 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2014-03-10 |
| Last Update Date: | 2020-09-30 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 207QA0401X | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | Group - Multi-Specialty |
| No | 2084A0401X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | Group - Multi-Specialty |
| No | 2084N0600X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Clinical Neurophysiology | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Multi-Specialty |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | Group - Multi-Specialty |
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| FL | 010784000 | Medicaid | |
| FL | 017439500 | Medicaid | |
| FL | 010785500 | Medicaid | |
| FL | 010785506 | Medicaid | |
| FL | 022832900 | Medicaid | |
| FL | 010785504 | Medicaid | |
| FL | 010785509 | Medicaid | |
| FL | 010785508 | Medicaid |
