Healthcare Provider Details

I. General information

NPI: 1285547752
Provider Name (Legal Business Name): KATHERINE MARY PHILLIPS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2281 LEE RD STE 105
WINTER PARK FL
32789-7208
US

IV. Provider business mailing address

29 GOLF TERRACE DR APT 201
WINTER SPRINGS FL
32708-5726
US

V. Phone/Fax

Practice location:
  • Phone: 877-264-6747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: