Provider Demographics
NPI:1770033748
Name:FLORIDA CHILDREN'S INSTITUTE
Entity Type:Organization
Organization Name:FLORIDA CHILDREN'S INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:BAKER
Authorized Official - Last Name:SIMMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D
Authorized Official - Phone:904-374-6403
Mailing Address - Street 1:8777 SAN JOSE BLVD
Mailing Address - Street 2:SUITE 801
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4213
Mailing Address - Country:US
Mailing Address - Phone:904-374-6403
Mailing Address - Fax:
Practice Address - Street 1:8777 SAN JOSE BLVD
Practice Address - Street 2:SUITE 801
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4213
Practice Address - Country:US
Practice Address - Phone:904-374-6403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-16-22849251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health