Provider Demographics
NPI:1942076716
Name:DAVILA-RODRIGUEZ, KATHERINE JISSEL
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JISSEL
Last Name:DAVILA-RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:JISSEL
Other - Last Name:DAVILA ORELLANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:57 W BURNSIDE AVE FL B1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-4038
Mailing Address - Country:US
Mailing Address - Phone:718-839-8900
Mailing Address - Fax:
Practice Address - Street 1:57 W BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4038
Practice Address - Country:US
Practice Address - Phone:718-839-8900
Practice Address - Fax:718-299-4030
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122217104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker