Healthcare Provider Details

I. General information

NPI: 1780985515
Provider Name (Legal Business Name): CATHIANA PHILIPPE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST FL 7
JACKSONVILLE FL
32214-5554
US

IV. Provider business mailing address

2080 CHILD ST FL 7TH
JACKSONVILLE FL
32214-5005
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-7354
  • Fax: 888-410-0935
Mailing address:
  • Phone: 904-425-7354
  • Fax: 888-410-0935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number073226
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 12435
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: