Provider Demographics
NPI:1659473049
Name:QUEVEDO, KATIA (PY)
Entity type:Individual
Prefix:
First Name:KATIA
Middle Name:
Last Name:QUEVEDO
Suffix:
Gender:F
Credentials:PY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13205 NW 7TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-2282
Mailing Address - Country:US
Mailing Address - Phone:305-798-7317
Mailing Address - Fax:
Practice Address - Street 1:2103 CORAL WAY STE 405
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2630
Practice Address - Country:US
Practice Address - Phone:305-445-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11168101YM0800X
FLPY11260103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health