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8617 E Colonial Dr Suite 1100 Orlando FL 32817-3938 | |
| (407) 895-0801 | |
| (407) 895-0803 |
| Full Name | |
|---|---|
| Speciality | Behavior Analyst |
| Location | 8617 E Colonial Dr, Orlando, Florida |
| Authorized Official Name and Position | Marucci Guzman (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4078950801 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
8617 E Colonial Dr Ste 1600 Orlando FL 32817-3937 Ph: (407) 895-0801 | 8617 E Colonial Dr Suite 1100 Orlando FL 32817-3938 Ph: (407) 895-0801 |
| NPI Number | 1861882631 |
|---|---|
| Provider Enumeration Date | 01/30/2015 |
| Last Update Date | 01/30/2024 |
| Certification Date | 01/30/2024 |
| Medicare PECOS PAC ID | 8224370788 |
|---|---|
| Medicare Enrollment ID | O20190502000998 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861882631 | NPI | - | NPPES |
| 015526400 | Medicaid | FL | |
| 015270300 | Medicaid | FL | |
| 014503400 | Medicaid | FL | |
| 017975600 | Medicaid | FL |
| Provider Name | Carmen C Capella |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1013088681 PECOS PAC ID: 8628254653 Enrollment ID: I20180821001396 |
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