Provider Demographics
NPI:1851158562
Name:MARCELIN, KATIANA
Entity Type:Individual
Prefix:
First Name:KATIANA
Middle Name:
Last Name:MARCELIN
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 1:375 WYMORE RD APT 204
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-5114
Mailing Address - Country:US
Mailing Address - Phone:321-460-9677
Mailing Address - Fax:
Practice Address - Street 1:375 WYMORE RD APT 204
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-5114
Practice Address - Country:US
Practice Address - Phone:321-460-9677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-323505106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician