MEDICARE: KATHERINE SOFIA DE LEON RMHCI AND RMFTI

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	101YM0800X	Mental Health Counselor	IMH16612	FL
2	106H00000X	Marriage & Family Therapist	IMT2825	FL

General Provider Information

NPI Number	:	1558907246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE SOFIA DE LEON RMHCI AND RMFTI

Provider Business Mailing Address
First Line	:	1504 BAY RD APT 1003
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-3130
Country	:	US
Telephone Number	:	917-757-8973
Fax Number	:

Provider Business Practice Location Address
First Line	:	1504 BAY RD APT 1003
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-3130
Country	:	US
Telephone Number	:	917-757-8973
Fax Number	:

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

Provider Enumeration Date	:	11/18/2019
Last Update Date	:	11/18/2019

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