Provider Demographics
NPI:1386708204
Name:CHILDREN'S ADVOCACY CENTER OF SWFL
Entity type:Organization
Organization Name:CHILDREN'S ADVOCACY CENTER OF SWFL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-939-2808
Mailing Address - Street 1:3900 BROADWAY
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8193
Mailing Address - Country:US
Mailing Address - Phone:239-939-2808
Mailing Address - Fax:239-939-4794
Practice Address - Street 1:3900 BROADWAY
Practice Address - Street 2:SUITE B-1
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8193
Practice Address - Country:US
Practice Address - Phone:239-939-2808
Practice Address - Fax:239-939-4794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health