Provider Demographics
NPI:1801471008
Name:BATDORF, FAITH
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:BATDORF
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 1:4959 CROMEY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34288-7903
Mailing Address - Country:US
Mailing Address - Phone:812-677-6134
Mailing Address - Fax:
Practice Address - Street 1:22655 BAYSHORE RD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2018
Practice Address - Country:US
Practice Address - Phone:941-451-9743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CORBT-21-184123106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician