Provider Demographics
NPI:1427671635
Name:FOOTMAN, KATARINA (LBS, BCBA)
Entity type:Individual
Prefix:
First Name:KATARINA
Middle Name:
Last Name:FOOTMAN
Suffix:
Gender:F
Credentials:LBS, BCBA
Other - Prefix:
Other - First Name:KATARINA
Other - Middle Name:
Other - Last Name:ONDREJCAKOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:1407 WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-9000
Practice Address - Country:US
Practice Address - Phone:717-845-2482
Practice Address - Fax:717-843-2170
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003426103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
14689243OtherCAQH
PABH003426OtherSTATE LICENSE