Provider Demographics
NPI:1073245122
Name:CAULFIELD, MARY COLLEEN (PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:COLLEEN
Last Name:CAULFIELD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 BRENTFORD CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1621
Mailing Address - Country:US
Mailing Address - Phone:541-390-9094
Mailing Address - Fax:
Practice Address - Street 1:307 BRENTFORD CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1621
Practice Address - Country:US
Practice Address - Phone:541-390-9094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool