Provider Demographics
NPI:1104357086
Name:EVAN, CAITLIN ALYSE
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ALYSE
Last Name:EVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 FOX POINTE PL
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-1537
Mailing Address - Country:US
Mailing Address - Phone:412-352-7340
Mailing Address - Fax:
Practice Address - Street 1:66 FOX POINTE PL
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-1537
Practice Address - Country:US
Practice Address - Phone:412-352-7340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW130249104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker