Healthcare Provider Details

I. General information

NPI: 1922411917
Provider Name (Legal Business Name): CATHERINA POPA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 SE RIVERSIDE DR
STUART FL
34994-2584
US

IV. Provider business mailing address

465 SE RIVERSIDE DR
STUART FL
34994-2584
US

V. Phone/Fax

Practice location:
  • Phone: 772-812-7907
  • Fax: 877-857-2217
Mailing address:
  • Phone: 772-812-7907
  • Fax: 877-857-2217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 13243
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: