Provider Demographics
NPI:1992314488
Name:WELLPATH BEHAVIORAL AND PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:WELLPATH BEHAVIORAL AND PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:PYD
Authorized Official - Phone:305-815-6167
Mailing Address - Street 1:3720 19TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34117-6142
Mailing Address - Country:US
Mailing Address - Phone:305-815-6167
Mailing Address - Fax:
Practice Address - Street 1:3720 19TH AVE SW
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34117-6142
Practice Address - Country:US
Practice Address - Phone:305-815-6167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty