Basic Information
| Provider Information | |||||||||
| NPI: | 1962838011 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAVINO | ||||||||
| FirstName: | CATHERINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3520 OAKS WAY | ||||||||
| Address2: | SUITE 904 | ||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330695391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862940537 | ||||||||
| FaxNumber: | 3053970308 | ||||||||
| Practice Location | |||||||||
| Address1: | 3900 NW 79TH AVE | ||||||||
| Address2: | SUITE 501 | ||||||||
| City: | DORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331666556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055973861 | ||||||||
| FaxNumber: | 3055973863 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2013 | ||||||||
| LastUpdateDate: | 12/18/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | FL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 103K00000X | FL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.