Provider Demographics
NPI:1912559956
Name:DEBERRY, CATHERINE (RBT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:DEBERRY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 KELLEY CV
Mailing Address - Street 2:
Mailing Address - City:PASS CHRISTIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39571-2226
Mailing Address - Country:US
Mailing Address - Phone:504-756-9044
Mailing Address - Fax:
Practice Address - Street 1:9480 THREE RIVERS RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4248
Practice Address - Country:US
Practice Address - Phone:228-313-3106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician