Organization
KIDSPACE BEHAVIORAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAUL SOTO III (PARTNER)
(305) 527-4961
Entity
Organization
Contact information
Practice address
12811 KENWOOD LN STE 113, FORT MYERS, FL 33907-5645
(239) 205-5148
Mailing address
15291 NW 60TH AVE STE 101, MIAMI LAKES, FL 33014-2459
(305) 527-4961
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/13/2022
Last updated
09/21/2022
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