Provider Demographics
NPI:1043368483
Name:KATZENBERG, BARBARA (MA, MED)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:KATZENBERG
Suffix:
Gender:F
Credentials:MA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-3418
Mailing Address - Country:US
Mailing Address - Phone:843-272-8276
Mailing Address - Fax:843-272-8276
Practice Address - Street 1:9222 BEACH DR
Practice Address - Street 2:STE. 6B
Practice Address - City:CALABASH
Practice Address - State:NC
Practice Address - Zip Code:28467-2960
Practice Address - Country:US
Practice Address - Phone:910-575-7995
Practice Address - Fax:843-272-8276
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4588101YP2500X
SC4655101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102051Medicaid