Provider Demographics
NPI:1609370907
Name:BARBOSA, KATHERINE FERNANDES
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:FERNANDES
Last Name:BARBOSA
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 1:1926 W. BEVERLY BLVD.
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057
Mailing Address - Country:US
Mailing Address - Phone:323-804-0178
Mailing Address - Fax:
Practice Address - Street 1:1926 W. BEVERLY BLVD.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-9005
Practice Address - Country:US
Practice Address - Phone:323-804-0178
Practice Address - Fax:323-804-0178
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor