MEDICARE: KATHERINE STUBBLEFIELD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst		FL
2	103TC0700X	Clinical Psychologist	11750	FL

General Provider Information

NPI Number	:	1225450091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE STUBBLEFIELD

Provider Business Mailing Address
First Line	:	5401 N UNIVERSITY DR STE 202
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-4636
Country	:	US
Telephone Number	:	954-288-9393
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 N UNIVERSITY DR STE 202
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-4636
Country	:	US
Telephone Number	:	954-288-9393
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2014
Last Update Date	:	05/04/2023

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Directions to “ KATHERINE STUBBLEFIELD ” Practice Location

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