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General NPI Number Information
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NPI Number | 1710472485
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Entity Type | Individual
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Provider Name | CATHLEEN H WIEDEL
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Gender | Female
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 01/17/2026
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Provider Practice Location Address
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Address Line | 1317 EDGEWATER DR # 498
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City | ORLANDO
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State | FL
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Zip | 32804-6350
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Country | US
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Telephone | 254-362-2271
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Fax |
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Provider Business Mailing Address
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Address Line | 4741 SW 14TH ST
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City | DEERFIELD BEACH
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State | FL
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Zip | 33442-8239
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Country | US
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Telephone | 954-652-6664
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT5269
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License Number State | FL
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