Provider Demographics
NPI:1184166100
Name:DNA COMPREHENSIVE THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:DNA COMPREHENSIVE THERAPY SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSORETZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:239-236-8784
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:833-362-7935
Mailing Address - Fax:239-561-2933
Practice Address - Street 1:6360 TECHSTER BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-4805
Practice Address - Country:US
Practice Address - Phone:239-223-2751
Practice Address - Fax:239-561-2933
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DNA COMPREHENSIVE THERAPY SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-08
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014482100Medicaid
FLHV955AMedicare PIN