Provider Demographics
NPI:1649597659
Name:PONCZEK, CATHY (LMFT, CAP)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:PONCZEK
Suffix:
Gender:F
Credentials:LMFT, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9730 NW 63RD PL
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-1806
Mailing Address - Country:US
Mailing Address - Phone:954-398-0714
Mailing Address - Fax:954-753-3125
Practice Address - Street 1:4699 N FEDERAL HWY
Practice Address - Street 2:SUITE #101A
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-6510
Practice Address - Country:US
Practice Address - Phone:954-790-4420
Practice Address - Fax:954-753-3125
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2314106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist