Provider Demographics
NPI:1871007831
Name:PADILLA, KATRINA E
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:E
Last Name:PADILLA
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 1:5 PINE ST
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1104
Mailing Address - Country:US
Mailing Address - Phone:203-667-9875
Mailing Address - Fax:
Practice Address - Street 1:5 PINE ST
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1104
Practice Address - Country:US
Practice Address - Phone:203-667-9875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
0-04-1193OtherBEHAVIOR ANALYST CERTIFICATION BOARD