Provider Demographics
NPI:1740913466
Name:EMBRACE LIFE PSYCHOTHERAPY SERVICES
Entity type:Organization
Organization Name:EMBRACE LIFE PSYCHOTHERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GISELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADORNO CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:321-402-3417
Mailing Address - Street 1:2675 GOLD DUST CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5156
Mailing Address - Country:US
Mailing Address - Phone:321-402-3417
Mailing Address - Fax:
Practice Address - Street 1:2675 GOLD DUST CIR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5156
Practice Address - Country:US
Practice Address - Phone:321-402-3417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-09
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty