Organization
ADVANCED CHILDRENS THERAPY INC
Active
Other names
ADVANCED CHILDRENS THERAPY
Organization subpart
No
Provider details
NPI number
Authorized official
MARLYE GONZALEZ ALFONSO (ADMINISTRATOR)
(561) 260-1316
Entity
Organization
Contact information
Practice address
2119 10TH AVE N, LAKE WORTH BEACH, FL 33461-3345
(561) 629-6882
(561) 828-3102
Mailing address
2119 10TH AVE N, LAKE WORTH BEACH, FL 33461-3345
(561) 629-6882
(561) 828-3102
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
252Y00000X
Early Intervention Provider Agency
—
—
261Q00000X
Clinic/Center
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025094700
—
FL
05
—
105119800
—
FL
Enumeration date
08/21/2019
Last updated
02/26/2023
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