Basic Information
| Provider Information | |||||||||
| NPI: | 1063512671 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KATOVSICH | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | BENNETT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHD, LLP, LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 903 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490851426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699852000 | ||||||||
| FaxNumber: | 2699852002 | ||||||||
| Practice Location | |||||||||
| Address1: | 903 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490851426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699852000 | ||||||||
| FaxNumber: | 2699852002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2006 | ||||||||
| LastUpdateDate: | 02/13/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801080778 | MI | N | Behavioral Health & Social Service Providers | Social Worker | 103TC0700X | 6301013818 | MI | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 1041C0700X | 6801080778 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 103T00000X | 6301013818 | MI | N | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | RK080778 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 8008979580 | 01 | MI | BCBS | OTHER |