Provider Demographics
NPI:1275074338
Name:FOSTER, SYCTRILOS YVETTE (MA)
Entity Type:Individual
Prefix:
First Name:SYCTRILOS
Middle Name:YVETTE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 GARDNER OAKS LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-3551
Mailing Address - Country:US
Mailing Address - Phone:863-286-2144
Mailing Address - Fax:
Practice Address - Street 1:3150 GARDNER OAKS LN
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-3551
Practice Address - Country:US
Practice Address - Phone:863-286-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst