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NPI Code Detail

MEDICARE: DR. KATHERINE S WILBORN PHD, LCSW, BCD

MEDICARE: DR. KATHERINE S WILBORN PHD, LCSW, BCD
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
11041C0700XClinical Social WorkerSW 2128FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2E0846OTHERFLMEDICARE PART B

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619904976
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KATHERINE S WILBORN PHD, LCSW, BCD
Provider Business Mailing Address
First Line : 502 2ND AVE
Second Line :
City : MELBOURNE BEACH
State : FL
Zip : 32951-2512
Country : US
Telephone Number : 321-728-7011
Fax Number : 321-728-7011
Provider Business Practice Location Address
First Line : 1010 ATLANTIC ST
Second Line : SUITE A
City : MELBOURNE BEACH
State : FL
Zip : 32951-2364
Country : US
Telephone Number : 321-728-7011
Fax Number : 321-728-7011
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2006
Last Update Date : 03/15/2013

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