MEDICARE: DORIS DAY CROMARTIE MA, RMHCI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor		FL
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	38481	OTHER	FL	CONTROL NO FROM STATE OF FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALIT

General Provider Information

NPI Number	:	1386100246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORIS DAY CROMARTIE MA, RMHCI

Provider Business Mailing Address
First Line	:	3107 N 50TH ST STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-2302
Country	:	US
Telephone Number	:	813-635-0606
Fax Number	:

Provider Business Practice Location Address
First Line	:	3107 N 50TH ST STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-2302
Country	:	US
Telephone Number	:	813-635-0606
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2019
Last Update Date	:	02/15/2019

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