Healthcare Provider Details

I. General information

NPI: 1851863666
Provider Name (Legal Business Name): KATHERINE SEVASTY HATZITHEODOROU LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4776 NEW BROAD ST STE 201
ORLANDO FL
32814-6423
US

IV. Provider business mailing address

4776 NEW BROAD ST STE 201
ORLANDO FL
32814-6423
US

V. Phone/Fax

Practice location:
  • Phone: 833-769-3524
  • Fax:
Mailing address:
  • Phone: 833-769-3524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT3204
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT3204
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: