Provider Demographics
NPI:1912916313
Name:HIGH, KATHERINE MARY (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARY
Last Name:HIGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3732 SAINT AUGUSTINE PL
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-4860
Mailing Address - Country:US
Mailing Address - Phone:813-727-2392
Mailing Address - Fax:
Practice Address - Street 1:3732 SAINT AUGUSTINE PL
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-4860
Practice Address - Country:US
Practice Address - Phone:813-727-2392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD062621041C0700X
FLSW 104281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD56RRMedicare ID - Type Unspecified