Basic Information
Provider Information
NPI: 1871689224
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DOSTER
FirstName: FATHIYYAH
MiddleName: KAAMILYA
NamePrefix:  
NameSuffix:  
Credential: BA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: MENTAL HEALTH CARE INC
Address2: 5707 N 22ND STREET
City: TAMPA
State: FL
PostalCode: 33610
CountryCode: US
TelephoneNumber: 8132722878
FaxNumber: 8132723766
Practice Location
Address1: MENTAL HEALTH CARE INC
Address2: 5707 N 22ND STREET
City: TAMPA
State: FL
PostalCode: 33610
CountryCode: US
TelephoneNumber: 8132722878
FaxNumber: 8132723766
Other Information
ProviderEnumerationDate: 10/05/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000X  Y Behavioral Health & Social Service ProvidersSocial Worker 

No ID Information.


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