Provider Demographics
NPI:1609222850
Name:HEADLEY, KATHRYN AURORA
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:AURORA
Last Name:HEADLEY
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 1:270 SW 112TH TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3410
Mailing Address - Country:US
Mailing Address - Phone:954-449-3740
Mailing Address - Fax:
Practice Address - Street 1:270 SW 112TH TER
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-3410
Practice Address - Country:US
Practice Address - Phone:954-449-3740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician