MEDICARE: KATHY ALTIDOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	101YM0800X	Mental Health Counselor	MH25156	FL

General Provider Information

NPI Number	:	1275241481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY ALTIDOR

Provider Business Mailing Address
First Line	:	4731 PINE CONE LN
Second Line	:
City	:	WEST PALM BCH
State	:	FL
Zip	:	33417-4609
Country	:	US
Telephone Number	:	561-201-1417
Fax Number	:

Provider Business Practice Location Address
First Line	:	4731 PINE CONE LN
Second Line	:
City	:	WEST PALM BCH
State	:	FL
Zip	:	33417-4609
Country	:	US
Telephone Number	:	561-201-1417
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2022
Last Update Date	:	06/26/2025

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Directions to “ KATHY ALTIDOR ” Practice Location

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