Taxonomy Code 322D00000X(322d00000x)
Emotionally Disturbed Childrens' Residential Treatment Facility. Providers: 1

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Emotionally Disturbed Childrens' Residential Treatment Facility Providers

NPI Name Type Address

1104050178

MRS. LICSW Laura Ann Stafford

Individual

12550 New Brittany Blvd

Suite 201

Fort Myers, FL

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Taxonomy Code 322D00000X
Display Name Emotionally Disturbed Childrens' Residential Treatment Facility
Taxonomy Group Residential Treatment Facilities
Taxonomy Classification Residential Treatment Facility, Emotionally Disturbed Children
Definition A residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently.
Effective Date September 30, 2009
Modification Date September 30, 2009
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