Provider Demographics
NPI:1558520148
Name:FLORIDA INSTITUTE OF TECHNOLOGY
Entity Type:Organization
Organization Name:FLORIDA INSTITUTE OF TECHNOLOGY
Other - Org Name:NONPROFIT
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL OPERATIONS ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-674-8106
Mailing Address - Street 1:150 W UNIVERSITY BLVD
Mailing Address - Street 2:THE SCOTT CENTER FOR AUTISM TREATMENT
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-6975
Mailing Address - Country:US
Mailing Address - Phone:321-674-8106
Mailing Address - Fax:321-674-8411
Practice Address - Street 1:150 W UNIVERSITY BLVD
Practice Address - Street 2:THE SCOTT CENTER FOR AUTISM TREATMENT
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-674-8106
Practice Address - Fax:321-674-8411
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA INSTITUTE OF TECHNOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-09
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X, 103T00000X, 235Z00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017501800Medicaid