Provider Demographics
NPI:1164763702
Name:CRUM, CAITLIN MONICA
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MONICA
Last Name:CRUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAITI
Other - Middle Name:MONICA
Other - Last Name:CRUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:920 SEAVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-3011
Mailing Address - Country:US
Mailing Address - Phone:415-271-2930
Mailing Address - Fax:
Practice Address - Street 1:400 29TH ST
Practice Address - Street 2:STE. 102
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3522
Practice Address - Country:US
Practice Address - Phone:510-239-3064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84338106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist