Provider Demographics
NPI:1003780024
Name:MACOMBER, KATHERINE (RBT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MACOMBER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 SAND LAKE RD STE 230
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-9138
Mailing Address - Country:US
Mailing Address - Phone:800-378-7597
Mailing Address - Fax:877-399-5578
Practice Address - Street 1:9367 TREVARTHON RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-2609
Practice Address - Country:US
Practice Address - Phone:407-681-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-460065106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty