MEDICARE: KATHERINE BEJERANO

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	247200000X	Other Technician
2	103K00000X	Behavior Analyst	1-21-51630	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710488705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE BEJERANO

Provider Business Mailing Address
First Line	:	7108 S KANNER HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-7462
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9160 FORUM CORPORATE PKWY
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-7805
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

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

Provider Enumeration Date	:	02/24/2018
Last Update Date	:	07/26/2021

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Directions to “ KATHERINE BEJERANO ” Practice Location

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