Provider Demographics
NPI:1427407261
Name:BORTNIAK, KATHERINE MARY (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARY
Last Name:BORTNIAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 VILLAGE BLVD APT 906
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-2847
Mailing Address - Country:US
Mailing Address - Phone:561-704-9542
Mailing Address - Fax:
Practice Address - Street 1:7731 N MILITARY TRL
Practice Address - Street 2:SUITE #4
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-7430
Practice Address - Country:US
Practice Address - Phone:561-244-9499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW190361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical