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8290 College Pkwy Suite 202 Fort Myers FL 33919-5124 | |
| (239) 466-2000 | |
| (239) 466-0640 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 8290 College Pkwy, Fort Myers, Florida |
| Authorized Official Name and Position | Brett Ian Cohen (COO) |
| Authorized Official Contact | 8003885150 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
313 Congress St Boston MA 02210-1218 Ph: (800) 388-5150 | 8290 College Pkwy Suite 202 Fort Myers FL 33919-5124 Ph: (239) 466-2000 |
| NPI Number | 1144387663 |
|---|---|
| Provider Enumeration Date | 01/03/2007 |
| Last Update Date | 03/04/2023 |
| Certification Date | 03/04/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144387663 | NPI | - | NPPES |
| 766155000 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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