NPIMap

Organization Active NPI

Metamorphosis Therapy LLC

  • Behavior Technician
  • Winter Garden, FL
National Provider Identifier
1477008407
Registry record updated Aug 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
Legal business name
METAMORPHOSIS THERAPY LLC
Practice address
1450 Daniels Rd
Winter Garden, FL 34787-4376
Phone
(407) 395-9976
NPI assigned
Aug 19, 2016
Last updated
Aug 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bridgett Elaine Dimant, SLPNPI 1053489328
Title
Owner
Phone
(407) 285-7907

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X
Behavior TechnicianGroup: 193200000X MULTI-SPECIALTY GROUP 106S00000X Primary

Addresses

Primary practice location

1450 Daniels Rd
Winter Garden, FL 34787-4376

Mailing address

13750 W Colonial Dr Ste 350-121
Winter Garden, FL 34787-4204
Phone (407) 395-9976

Other identifiers 1

IdentifierTypeStateIssuer
017434700MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Metamorphosis Therapy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1222 Winter Garden Vineland Rd
Ste 108
Winter Garden, FL 34787
Phone (407) 395-9976

13750 W Colonial Dr
Ste 350121
Winter Garden, FL 34787
Phone (407) 285-7907

1450 Daniels Rd
Winter Garden, FL 34787
Phone (407) 395-9976

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1471564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692662400000",
    "number": "1477008407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13750 W COLONIAL DR STE 350-121",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347874204",
            "telephone_number": "407-395-9976",
            "fax_number": "407-992-9368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 DANIELS RD",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347874376",
            "telephone_number": "407-395-9976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METAMORPHOSIS THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-19",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A",
        "authorized_official_last_name": "DIMANT",
        "authorized_official_first_name": "BRIDGETT",
        "authorized_official_middle_name": "ELAINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-285-7907",
        "authorized_official_credential": "SLP"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017434700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Garden, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.