Provider Demographics
NPI:1699421560
Name:KATOVICH, NATASCHA (LCSW)
Entity type:Individual
Prefix:
First Name:NATASCHA
Middle Name:
Last Name:KATOVICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1646
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32056-1646
Mailing Address - Country:US
Mailing Address - Phone:773-531-6692
Mailing Address - Fax:
Practice Address - Street 1:4812 W US HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-5126
Practice Address - Country:US
Practice Address - Phone:386-466-1106
Practice Address - Fax:386-466-1802
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SW102581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical