Provider Demographics
NPI:1093848020
Name:IGO, CATHERINE JANE (LCSW, CEAP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:JANE
Last Name:IGO
Suffix:
Gender:F
Credentials:LCSW, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 POPE AVE NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4665
Mailing Address - Country:US
Mailing Address - Phone:863-370-7281
Mailing Address - Fax:863-292-2201
Practice Address - Street 1:630 POPE AVE NW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4665
Practice Address - Country:US
Practice Address - Phone:863-370-7281
Practice Address - Fax:863-292-2201
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW48731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82781399OtherUBH
FL64658OtherCERIDIAN