Provider Demographics
NPI:1497114359
Name:COLET, CATHY
Entity Type:Individual
Prefix:DR
First Name:CATHY
Middle Name:
Last Name:COLET
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 1:744 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3005
Mailing Address - Country:US
Mailing Address - Phone:772-223-9988
Mailing Address - Fax:772-223-9593
Practice Address - Street 1:744 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3005
Practice Address - Country:US
Practice Address - Phone:772-223-9988
Practice Address - Fax:772-223-9593
Is Sole Proprietor?:No
Enumeration Date:2016-02-19
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9058103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1497114359Medicare UPIN