Provider Demographics
NPI:1770018483
Name:FLORIDA CENTER FOR ATTACHMENT & TRAUMA, LLC
Entity Type:Organization
Organization Name:FLORIDA CENTER FOR ATTACHMENT & TRAUMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BARTLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, CWCM
Authorized Official - Phone:813-712-9975
Mailing Address - Street 1:2001 RIVER PARK CT
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-7233
Mailing Address - Country:US
Mailing Address - Phone:813-712-9975
Mailing Address - Fax:
Practice Address - Street 1:2100 CONSTITUTION BLVD STE 115
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-4146
Practice Address - Country:US
Practice Address - Phone:813-712-9975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency