Provider Demographics
NPI:1134387103
Name:DOOLITTLE, MARY (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DOOLITTLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALLYE
Other - Middle Name:
Other - Last Name:DOOLITTLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, MSW
Mailing Address - Street 1:9649 LAKE JASMINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626
Mailing Address - Country:US
Mailing Address - Phone:904-502-9557
Mailing Address - Fax:
Practice Address - Street 1:9649 LAKE JASMINE DRIVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626
Practice Address - Country:US
Practice Address - Phone:904-502-9557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW72431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766087100Medicaid