Provider Demographics
NPI:1396389292
Name:SOBRADO, KATHRYN D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:D
Last Name:SOBRADO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KATY
Other - Middle Name:
Other - Last Name:SOBRADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:8525 SW 92ND ST STE D17
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7378
Mailing Address - Country:US
Mailing Address - Phone:305-857-5134
Mailing Address - Fax:
Practice Address - Street 1:8525 SW 92ND ST STE D17
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7378
Practice Address - Country:US
Practice Address - Phone:305-857-5134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9570103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical