Provider Demographics
NPI:1437232089
Name:BISHOP, KATHERINE ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:BISHOP
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 1:1065 W MORSE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3747
Mailing Address - Country:US
Mailing Address - Phone:407-644-1122
Mailing Address - Fax:407-644-6554
Practice Address - Street 1:1065 W MORSE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3747
Practice Address - Country:US
Practice Address - Phone:407-644-1122
Practice Address - Fax:407-644-6554
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00013211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ2850Medicare ID - Type Unspecified