Provider Demographics
NPI:1164986386
Name:HENCK, CAITLIN TAYLOR (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:TAYLOR
Last Name:HENCK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:CAITLIN
Other - Middle Name:TAYLOR
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37 TALCOTT ROAD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495
Mailing Address - Country:US
Mailing Address - Phone:802-662-7831
Mailing Address - Fax:802-662-7834
Practice Address - Street 1:37 TALCOTT ROAD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495
Practice Address - Country:US
Practice Address - Phone:802-662-7831
Practice Address - Fax:802-662-7834
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst