Healthcare Provider Details

I. General information

NPI: 1992623854
Provider Name (Legal Business Name): PRISM PSYCHOTHERAPY, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S PALMWAY APT 8
LAKE WORTH BEACH FL
33460-4276
US

IV. Provider business mailing address

101 S PALMWAY APT 8
LAKE WORTH BEACH FL
33460-4276
US

V. Phone/Fax

Practice location:
  • Phone: 407-917-2205
  • Fax:
Mailing address:
  • Phone: 407-917-2205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. CATHERINE REVAK
Title or Position: OWNER / PSYCHOTHERAPIST
Credential:
Phone: 407-917-2205