Provider Demographics
NPI:1275241481
Name:ALTIDOR, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:ALTIDOR
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 1:4731 PINE CONE LN
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BCH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-4609
Mailing Address - Country:US
Mailing Address - Phone:561-201-1417
Mailing Address - Fax:
Practice Address - Street 1:4731 PINE CONE LN
Practice Address - Street 2:
Practice Address - City:WEST PALM BCH
Practice Address - State:FL
Practice Address - Zip Code:33417-4609
Practice Address - Country:US
Practice Address - Phone:561-201-1417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health