Provider Demographics
NPI:1750721999
Name:KAIUWAY, KATRINA (BACHELOR LEVEL)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:KAIUWAY
Suffix:
Gender:F
Credentials:BACHELOR LEVEL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2357 CALADIUM RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-4012
Mailing Address - Country:US
Mailing Address - Phone:904-554-4124
Mailing Address - Fax:
Practice Address - Street 1:435 CLARK RD STE 107
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-5558
Practice Address - Country:US
Practice Address - Phone:904-554-4124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health