| Doctor Name: | DR. KATHERINE S WILBORN |
| NPI Number: | 1619904976 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD, LCSW, BCD |
| License Number: | SW 2128 |
| Business Practice Address: | 1010 Atlantic St Suite A Melbourne Beach, FL - 329512364 |
| Business Phone Number: | 3217287011 |
| Business Fax Number: | 3217287011 |
| Mailing Address: | 502 2nd Ave, MELBOURNE BEACH |
| State: | FL |
| Postal Code: | 329512512 |
| Phone Number: | 3217287011 |
| Fax Number: | 3217287011 |
| NPI Enumeration Date: | 06/26/2006 |
| NPI Last Update Date: | 03/15/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | SW 2128 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |