Healthcare Provider Details

I. General information

NPI: 1104312784
Provider Name (Legal Business Name): CRYSTAL CATALINA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2161 PALM BEACH LAKES BLVD STE 208
WEST PALM BEACH FL
33409-6611
US

IV. Provider business mailing address

2571 SE SNAPPER ST
PORT ST LUCIE FL
34952-5334
US

V. Phone/Fax

Practice location:
  • Phone: 561-291-9593
  • Fax:
Mailing address:
  • Phone: 713-992-6844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW26483
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number66129
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: