Provider Demographics
NPI:1578324612
Name:AVILA, KATHERINE (RBT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:AVILA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 E 22ND ST FL 2
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07513-1614
Mailing Address - Country:US
Mailing Address - Phone:862-204-8158
Mailing Address - Fax:
Practice Address - Street 1:1037 E 22ND ST FL 2
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07513-1614
Practice Address - Country:US
Practice Address - Phone:862-238-1375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRBT-23-290181106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician