MEDICARE: CATHLEEN H WIEDEL

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	106H00000X	Marriage & Family Therapist	MT5269	FL

General Provider Information

NPI Number	:	1710472485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHLEEN H WIEDEL

Provider Business Mailing Address
First Line	:	4741 SW 14TH ST
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-8239
Country	:	US
Telephone Number	:	954-652-6664
Fax Number	:

Provider Business Practice Location Address
First Line	:	1317 EDGEWATER DR # 498
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-6350
Country	:	US
Telephone Number	:	254-362-2271
Fax Number	:

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

Provider Enumeration Date	:	06/26/2018
Last Update Date	:	01/17/2026

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