Provider Demographics
NPI:1508154964
Name:BISHOP, DEITRIA L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DEITRIA
Middle Name:L
Last Name:BISHOP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:DEITRIA
Other - Middle Name:L
Other - Last Name:DAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:800 NW 15TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1412
Mailing Address - Country:US
Mailing Address - Phone:305-755-6500
Mailing Address - Fax:305-372-1054
Practice Address - Street 1:17501 SW 117TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-2272
Practice Address - Country:US
Practice Address - Phone:305-254-9759
Practice Address - Fax:305-256-0037
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW 4702104100000X
FLSW113631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker