Provider Demographics
NPI:1245619436
Name:WELLWOOD, CAITLIN REBEKAH
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:REBEKAH
Last Name:WELLWOOD
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 1:110B MISSION DR
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2022
Mailing Address - Country:US
Mailing Address - Phone:805-607-3400
Mailing Address - Fax:
Practice Address - Street 1:110B MISSION DR
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2022
Practice Address - Country:US
Practice Address - Phone:805-607-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56CCOtherASPIRA