Provider Demographics
NPI:1093256935
Name:KATHRYN DOLL LLC
Entity Type:Organization
Organization Name:KATHRYN DOLL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-260-8667
Mailing Address - Street 1:8500 NW 79TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-1659
Mailing Address - Country:US
Mailing Address - Phone:954-260-8667
Mailing Address - Fax:
Practice Address - Street 1:9900 W SAMPLE RD STE 309
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4048
Practice Address - Country:US
Practice Address - Phone:954-260-8667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-11
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 14042251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health