Provider Demographics
NPI:1659137412
Name:IMACHA, KATHERIN (RBT-24-330019)
Entity Type:Individual
Prefix:
First Name:KATHERIN
Middle Name:
Last Name:IMACHA
Suffix:
Gender:F
Credentials:RBT-24-330019
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4357 SW 153RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5222
Mailing Address - Country:US
Mailing Address - Phone:305-302-2601
Mailing Address - Fax:
Practice Address - Street 1:4357 SW 153RD CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5222
Practice Address - Country:US
Practice Address - Phone:305-302-2601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-330019106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician