Healthcare Provider Details

I. General information

NPI: 1609794841
Provider Name (Legal Business Name): KATELYN BALLACCHINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 WILES RD
CORAL SPRINGS FL
33067-2036
US

IV. Provider business mailing address

3631 TURTLE RUN BLVD APT 721
CORAL SPRINGS FL
33067-4235
US

V. Phone/Fax

Practice location:
  • Phone: 786-514-6817
  • Fax:
Mailing address:
  • Phone: 786-514-6817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW23469
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: