Provider Demographics
NPI:1427591775
Name:BRUMBAUGH, CATHY (CMS)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:BRUMBAUGH
Suffix:
Gender:F
Credentials:CMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 551633
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33355-1633
Mailing Address - Country:US
Mailing Address - Phone:954-687-7978
Mailing Address - Fax:888-829-6348
Practice Address - Street 1:605 NE 9TH AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-1633
Practice Address - Country:US
Practice Address - Phone:954-687-7978
Practice Address - Fax:888-829-6348
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator