Provider Demographics
NPI:1134529407
Name:FANTAUZZI, CATHERINE MARTINO
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:MARTINO
Last Name:FANTAUZZI
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 1:5416 WHITE SANDS CV
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-1739
Mailing Address - Country:US
Mailing Address - Phone:561-436-9283
Mailing Address - Fax:
Practice Address - Street 1:5416 WHITE SANDS CV
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-1739
Practice Address - Country:US
Practice Address - Phone:561-436-9283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-24
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst