Healthcare Provider Details

I. General information

NPI: 1447450150
Provider Name (Legal Business Name): CATALINA Y GRANJA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 NW 70TH AVE
PLANTATION FL
33313-6028
US

IV. Provider business mailing address

1417 SE 4TH ST
FT LAUDERDALE FL
33301-2319
US

V. Phone/Fax

Practice location:
  • Phone: 954-463-2273
  • Fax: 954-779-1643
Mailing address:
  • Phone: 954-463-2273
  • Fax: 954-779-1643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 4838
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: