Provider Demographics
NPI:1104646991
Name:BATISTA, KATHERINE VICTORIA
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:VICTORIA
Last Name:BATISTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14831 SW 160TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-0800
Mailing Address - Country:US
Mailing Address - Phone:786-281-9342
Mailing Address - Fax:
Practice Address - Street 1:10447 SW 108TH AVE APT E278
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-8115
Practice Address - Country:US
Practice Address - Phone:786-645-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-373119103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty