Provider Demographics
NPI:1073881595
Name:TAYLOR, CATHERINE NOELANI (EDM)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:NOELANI
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 GENOA RD
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-2939
Mailing Address - Country:US
Mailing Address - Phone:904-540-7715
Mailing Address - Fax:
Practice Address - Street 1:315 GENOA RD
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-2939
Practice Address - Country:US
Practice Address - Phone:904-540-7715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst