Provider Demographics
NPI:1225145535
Name:BOURNE, CATHERINE L (MSW)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:L
Last Name:BOURNE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:CATHIE
Other - Middle Name:LISA
Other - Last Name:BOURNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7170 125TH ST
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-5503
Mailing Address - Country:US
Mailing Address - Phone:727-397-7974
Mailing Address - Fax:727-397-7974
Practice Address - Street 1:7170 125TH ST
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-5503
Practice Address - Country:US
Practice Address - Phone:727-397-7974
Practice Address - Fax:727-397-7974
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
FLMT917106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMT917OtherMFT STATE LICENSE NUMBER