Provider Demographics
NPI:1053832386
Name:CAULFIELD, MARY GETRUDE (MSH, LAT, MAC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:GETRUDE
Last Name:CAULFIELD
Suffix:
Gender:F
Credentials:MSH, LAT, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LANE LN
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-8630
Mailing Address - Country:US
Mailing Address - Phone:307-675-4100
Mailing Address - Fax:
Practice Address - Street 1:5 LANE LN
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-8630
Practice Address - Country:US
Practice Address - Phone:307-675-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY368101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)