Provider Demographics
NPI:1609275767
Name:KITCHEN, DORIS (SW)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:KITCHEN
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-467-0880
Mailing Address - Fax:954-535-2030
Practice Address - Street 1:1101 NW 1ST ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-8905
Practice Address - Country:US
Practice Address - Phone:954-467-0880
Practice Address - Fax:954-535-2030
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW85831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical