Provider Demographics
NPI:1952320210
Name:ANDERSON, DORIS STALLS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DORIS
Middle Name:STALLS
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 PARK ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-4348
Mailing Address - Country:US
Mailing Address - Phone:727-347-0354
Mailing Address - Fax:727-343-2400
Practice Address - Street 1:6168 1ST AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-8515
Practice Address - Country:US
Practice Address - Phone:727-347-7353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW16891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ2051AMedicare ID - Type UnspecifiedMEDICARE NUMBER