Provider Demographics
NPI:1962274456
Name:PALLIDINE, KATHERINE MICHELE
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:MICHELE
Last Name:PALLIDINE
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 1:7910 SW 137TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3115
Mailing Address - Country:US
Mailing Address - Phone:305-298-8087
Mailing Address - Fax:
Practice Address - Street 1:2020 PONCE DE LEON BLVD STE 1201
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4476
Practice Address - Country:US
Practice Address - Phone:305-917-5414
Practice Address - Fax:305-220-1864
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1018698106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician