Katherine S Wilborn, PHD, LCSW, BCD
Individual provider Active NPI Clinical Social Worker · Melbourne Beach, FL
NPI 1619904976 · NPPES record last updated Mar 15, 2013
Key facts
- NPI
- 1619904976
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- SW 2128 (FL)
- Practice address
- 1010 Atlantic St
Suite a
Melbourne Beach, FL 32951-2364 - Phone
- (321) 728-7011
- Fax
- (321) 728-7011
- NPI assigned
- Jun 26, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW 2128 | FL | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SW 2128 | FL | Yes |
Addresses
Primary practice location
1010 Atlantic St
Suite a
Melbourne Beach, FL 32951-2364
Mailing address
502 2ND Ave
Melbourne Beach, FL 32951-2512
Phone (321) 728-7011
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 230047000 | Medicaid | FL | |
| E0846 | Other | FL | MEDICARE PART B |
Other providers in Melbourne Beach, FL
- Kathryn Terrian
- Margaret Tworkowski
- Victoria Vitale-Lewis
- Joanna Walters
- Lindsey Anne Wheeler
- Laura Wilson
- Carl M Zippi
All providers in Melbourne Beach, FL · Clinical Social Worker in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 15, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.