Provider Demographics
NPI:1245789445
Name:WALDORF, CAITLIN (LMSW)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:WALDORF
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:
Other - Last Name:SAGANSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12200 E 13 MILE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3093
Mailing Address - Country:US
Mailing Address - Phone:586-573-1810
Mailing Address - Fax:
Practice Address - Street 1:12200 E 13 MILE RD STE 200
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3093
Practice Address - Country:US
Practice Address - Phone:586-573-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 1041C0700X
MI68011085011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801108501OtherMSW LICENSE