Provider Demographics
NPI:1740706092
Name:IVEY, CATHERINE GRACE (BCBA)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:GRACE
Last Name:IVEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5175 45TH ST N BLDG C
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33714-2266
Mailing Address - Country:US
Mailing Address - Phone:407-917-7060
Mailing Address - Fax:
Practice Address - Street 1:5449 S SEMORAN BLVD STE 205
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-1778
Practice Address - Country:US
Practice Address - Phone:407-917-7060
Practice Address - Fax:407-917-7060
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty