Doretha Michele McBride, LCSW, CADC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW16933 Issued in FL

Practice address

509 Millifiora LN
Kissimmee, FL 34759-4336

Phone

(219) 226-5567

Fax

(863) 496-5338

NPI assigned

Sep 11, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Life Skills Institute Company Nathan'S Place

  • Community/Behavioral Health Agency
  • Kissimmee, FL
  • NPI 1952754301
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1378857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591228800000",
    "number": "1871928606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 MILLIFIORA LN",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347594336",
            "telephone_number": "219-226-5567",
            "fax_number": "863-496-5338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 MILLIFIORA LN",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347594336",
            "telephone_number": "219-226-5567",
            "fax_number": "863-496-5338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCBRIDE",
        "first_name": "DORETHA",
        "middle_name": "MICHELE",
        "name_prefix": "Ms.",
        "credential": "LCSW, CADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-11",
        "last_updated": "2020-06-04",
        "certification_date": "2020-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "22796",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.015775",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34007000A",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW16933",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• MC Medical LLC
• James A McAleer, MD
• James McAllister Jr.
• Lena McBride-Ramos, PTA
• Daniel McBride, DC
• Allen McCall, DMD, MS
• Deidre McCall
• Nytionna L McClendon
• Kyle McClurg
• Lidia McCowan, COTA/L

• Clinical Social Worker in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.