Provider Demographics
NPI:1073652301
Name:STARK, CAITLIN PITTEL (PSYD)
Entity Type:Individual
Prefix:MS
First Name:CAITLIN
Middle Name:PITTEL
Last Name:STARK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:CAITLIN
Other - Middle Name:BROSSELL
Other - Last Name:PITTEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:70B JUNCTION SQUARE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742
Mailing Address - Country:US
Mailing Address - Phone:978-371-4433
Mailing Address - Fax:
Practice Address - Street 1:70 JUNCTION SQUARE DRIVE
Practice Address - Street 2:B
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-371-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7859103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical