Provider Demographics
NPI:1073946869
Name:VINTER, CAITLIN O'GALLAGHER (LICSW)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:O'GALLAGHER
Last Name:VINTER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:JESSIE
Other - Last Name:O'GALLAGHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:112 WATER ST STE 203
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4225
Mailing Address - Country:US
Mailing Address - Phone:857-293-9875
Mailing Address - Fax:857-250-4379
Practice Address - Street 1:112 WATER ST STE 203
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-4225
Practice Address - Country:US
Practice Address - Phone:857-293-9875
Practice Address - Fax:857-250-4379
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2017-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1199641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical