Provider Demographics
NPI:1366086332
Name:GOLDBERG, KATHERINE ANNE BROPHY (BCBA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE BROPHY
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ANNE
Other - Last Name:BROPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6301 CAMPUS CIRCLE DR E STE 110
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2705
Mailing Address - Country:US
Mailing Address - Phone:214-935-3688
Mailing Address - Fax:
Practice Address - Street 1:6301 CAMPUS CIRCLE DR E STE 110
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2705
Practice Address - Country:US
Practice Address - Phone:214-935-3688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-03
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
SC1-22-59815103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician