NPIMap

Organization Active NPI

The Ecotherapy Place LLC

  • Behavior Analyst
  • Alva, FL
National Provider Identifier
1992448161
Registry record updated Oct 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
THE ECOTHERAPY PLACE LLC
Practice address
18320 Persimmon Ridge Rd
Alva, FL 33920-2037
Phone
(239) 895-6954
NPI assigned
Apr 15, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2022

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

Authorized official

Name
Cristiane Fernandes, LCSWNPI 1982072815
Title
Clinician
Phone
(239) 895-6954

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 Primary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X

Addresses

Primary practice location

18320 Persimmon Ridge Rd
Alva, FL 33920-2037

Mailing address

PO Box 2037
Alva, FL 33920-2037
Phone (239) 895-6954

Other identifiers 2

IdentifierTypeStateIssuer
111229900MedicaidFL
114247300MedicaidFL

Electronic endpoints 2

TypeEndpointUseAffiliation
Other URL 1041c0700x
Other URL 1041c0700x

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1649980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665619200000",
    "number": "1992448161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2037",
            "city": "ALVA",
            "state": "FL",
            "postal_code": "339202037",
            "telephone_number": "239-895-6954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18320 PERSIMMON RIDGE RD",
            "city": "ALVA",
            "state": "FL",
            "postal_code": "339202037",
            "telephone_number": "239-895-6954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE ECOTHERAPY PLACE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-15",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A",
        "authorized_official_last_name": "FERNANDES",
        "authorized_official_first_name": "CRISTIANE",
        "authorized_official_title_or_position": "CLINICIAN",
        "authorized_official_telephone_number": "239-895-6954",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111229900",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114247300",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "1041c0700x",
            "affiliation": "N",
            "address_1": "18320 Persimmon Ridge RD",
            "city": "Alva",
            "state": "FL",
            "country_code": "US",
            "postal_code": "339202037",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "1041c0700x",
            "affiliation": "N",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "18320 Persimmon Ridge RD",
            "city": "Alva",
            "state": "FL",
            "country_code": "US",
            "postal_code": "339202037",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Alva, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2022; 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.