Provider Demographics
NPI:1558907246
Name:DE LEON, KATHERINE SOFIA (RMHCI AND RMFTI)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SOFIA
Last Name:DE LEON
Suffix:
Gender:F
Credentials:RMHCI AND RMFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 BAY RD APT 1003
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3130
Mailing Address - Country:US
Mailing Address - Phone:917-757-8973
Mailing Address - Fax:
Practice Address - Street 1:1504 BAY RD APT 1003
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-3130
Practice Address - Country:US
Practice Address - Phone:917-757-8973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH16612101YM0800X
FLIMT2825106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty