Provider Demographics
NPI:1912276387
Name:COLE, MARIA KATRINA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:KATRINA
Last Name:COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:KATRINA
Other - Last Name:BORROMEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6302 SOUTHERN HLS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244
Mailing Address - Country:US
Mailing Address - Phone:210-292-4452
Mailing Address - Fax:
Practice Address - Street 1:4102 WOOLWORTH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1899
Practice Address - Country:US
Practice Address - Phone:402-444-7330
Practice Address - Fax:402-996-8171
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9384101YM0800X
NELMHP-4245, CMSW 15031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE092619Medicaid